Provider Demographics
NPI:1982678769
Name:HASTINGS, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:HASTINGS
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 1:54182 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IN
Mailing Address - Zip Code:46507-9684
Mailing Address - Country:US
Mailing Address - Phone:574-307-0719
Mailing Address - Fax:
Practice Address - Street 1:609 W BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2900
Practice Address - Country:US
Practice Address - Phone:574-262-2817
Practice Address - Fax:574-262-2941
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027071A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112380AMedicaid
224730Medicare ID - Type UnspecifiedMEDICARE
IN100112380AMedicaid