Provider Demographics
NPI:1154572832
Name:HALEY, BENJAMIN PASCHAL (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:PASCHAL
Last Name:HALEY
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 1:410 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-8589
Mailing Address - Country:US
Mailing Address - Phone:318-255-8879
Mailing Address - Fax:
Practice Address - Street 1:410 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-8589
Practice Address - Country:US
Practice Address - Phone:318-255-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9529207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology