Provider Demographics
NPI:1972509818
Name:HAIGHT, EDWARD STEWART (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STEWART
Last Name:HAIGHT
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:PO BOX 1930
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-1930
Mailing Address - Country:US
Mailing Address - Phone:985-917-3007
Mailing Address - Fax:985-917-3010
Practice Address - Street 1:128 NEUROSCIENCE CT
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-5209
Practice Address - Country:US
Practice Address - Phone:985-917-3007
Practice Address - Fax:985-447-4209
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0231002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484382Medicaid
LA4A183Medicare PIN
LA4A183Medicare PIN
5F903Medicare PIN