Provider Demographics
NPI:1396731915
Name:HAYGOOD, BOLLING CROSS (MD)
Entity type:Individual
Prefix:DR
First Name:BOLLING
Middle Name:CROSS
Last Name:HAYGOOD
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE. 701
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-5864
Mailing Address - Fax:225-765-2013
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:STE. 701
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-5864
Practice Address - Fax:225-765-2013
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016209174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06305769Medicaid
LA1331503Medicaid
52192DX80Medicare PIN
MS06305769Medicaid