Provider Demographics
NPI:1932109923
Name:HASSELL, DAYNE DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAYNE
Middle Name:DANIEL
Last Name:HASSELL
Suffix:
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 1:835 ONEONTA ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1129
Mailing Address - Country:US
Mailing Address - Phone:318-869-1508
Mailing Address - Fax:
Practice Address - Street 1:835 ONEONTA ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1129
Practice Address - Country:US
Practice Address - Phone:318-869-1508
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3202R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA52486Medicaid
LA52486Medicaid
LAB63893Medicare UPIN