Provider Demographics
NPI:1891739884
Name:HADDOW, ALASTAIR D (MD)
Entity type:Individual
Prefix:
First Name:ALASTAIR
Middle Name:D
Last Name:HADDOW
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:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:2115 S FREMONT AVE
Practice Address - Street 2:SUITE 3050
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2239
Practice Address - Country:US
Practice Address - Phone:417-820-3905
Practice Address - Fax:417-820-3528
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2A37207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1974OtherCOX HEALTH SYSTEMS
AR110527001Medicaid
110193990OtherRAILROAD MEDICARE
172643OtherHEALTHLINK
18324OtherBCBS
MO201203338Medicaid
AR110527001Medicaid
MO132680044Medicare PIN
110193990OtherRAILROAD MEDICARE