Provider Demographics
NPI:1215126834
Name:HEARN, PAMELA R (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:HEARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:765 S BONNER ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270
Mailing Address - Country:US
Mailing Address - Phone:318-255-2733
Mailing Address - Fax:318-254-1066
Practice Address - Street 1:765 S BONNER ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-255-2733
Practice Address - Fax:318-254-1066
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018482LA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B62898Medicare UPIN