Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | P9870 | TX |
NPI | 1174597553 |
---|---|
Provider Name | Scott E Hastings |
First Address | Frisco, TX 75033-1217 |
Second Address | Frisco, TX 75033-1217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 01/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
896102 | (05) | AZ |
H75102 | (02) |