Provider Demographics
NPI:1255353033
Name:HAMIDE, JOHN PASTEUR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PASTEUR
Last Name:HAMIDE
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 6022
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70009
Mailing Address - Country:US
Mailing Address - Phone:504-309-1736
Mailing Address - Fax:504-309-1715
Practice Address - Street 1:8000 WEST JUDGE PEREZ DRIVE
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043
Practice Address - Country:US
Practice Address - Phone:504-826-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24935207RC0000X
LA0249352085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420999Medicaid
4J894Medicare ID - Type Unspecified
LA1420999Medicaid