Basic Information
| Provider Information | |||||||||
| NPI: | 1023170768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAWLEY | ||||||||
| FirstName: | MAURICE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9441 LBJ FWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752434500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726656963 | ||||||||
| FaxNumber: | 7702374731 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 GREENWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711033908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726646963 | ||||||||
| FaxNumber: | 7702374731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 04/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 018942 | LA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1393495 | 05 | LA | MEDICAID |