Provider Demographics
NPI:1295239002
Name:HASKINS, MATTHEW EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWIN
Last Name:HASKINS
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 1:10146 JIM WILLIE RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-7630
Mailing Address - Country:US
Mailing Address - Phone:985-237-8593
Mailing Address - Fax:
Practice Address - Street 1:10146 JIM WILLIE RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-7630
Practice Address - Country:US
Practice Address - Phone:985-237-8593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program