Provider Demographics
NPI:1578658555
Name:HAYDEL, RICHARD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:HAYDEL
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 1:502 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4606
Mailing Address - Country:US
Mailing Address - Phone:985-876-2150
Mailing Address - Fax:985-876-7413
Practice Address - Street 1:502 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4606
Practice Address - Country:US
Practice Address - Phone:985-876-2150
Practice Address - Fax:985-876-7413
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360546Medicaid
LAB63645Medicare UPIN
LA1360546Medicaid