Provider Demographics
NPI:1891791240
Name:HAYDEL, ROBERT DOUGLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:HAYDEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4752 HIGHWAY 311 STE 108
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2810
Mailing Address - Country:US
Mailing Address - Phone:985-857-8271
Mailing Address - Fax:985-655-8271
Practice Address - Street 1:4752 HIGHWAY 311 STE 108
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2810
Practice Address - Country:US
Practice Address - Phone:985-857-8271
Practice Address - Fax:985-655-8271
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019894207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1966444Medicaid
LA5D288Medicare PIN
LA1966444Medicaid