Provider Demographics
NPI:1013935964
Name:MUSTIN, HAROLD STEVENON III
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:STEVENON
Last Name:MUSTIN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 CLARA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-7030
Mailing Address - Country:US
Mailing Address - Phone:504-975-7596
Mailing Address - Fax:504-897-7008
Practice Address - Street 1:2021 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1352
Practice Address - Country:US
Practice Address - Phone:504-903-3370
Practice Address - Fax:504-897-7008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN094436-AP04472367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1465526Medicaid
4H996C493Medicare PIN