Provider Demographics
NPI:1992734453
Name:HAST, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:HAST
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 1919
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1919
Mailing Address - Country:US
Mailing Address - Phone:270-926-2273
Mailing Address - Fax:270-926-5200
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-2273
Practice Address - Fax:270-926-5200
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23051207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64230519Medicaid
KY110094553OtherRAILROAD MEDICARE
IN100007070Medicaid
KY000000045763OtherANTHEM BC/BS
KY64230519Medicaid
IN100007070Medicaid
KY610890594OtherEIN