Provider Demographics
NPI:1801991781
Name:HIATT, BARRY ALAN (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:ALAN
Last Name:HIATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8820 LADUE ROAD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2079
Mailing Address - Country:US
Mailing Address - Phone:314-754-3246
Mailing Address - Fax:314-446-3049
Practice Address - Street 1:8820 LADUE ROAD
Practice Address - Street 2:SUITE 308
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2079
Practice Address - Country:US
Practice Address - Phone:314-754-3246
Practice Address - Fax:314-446-3049
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR47832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10859Medicare UPIN
000003782Medicare ID - Type Unspecified