Basic Information
| Provider Information | |||||||||
| NPI: | 1891739884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADDOW | ||||||||
| FirstName: | ALASTAIR | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2580 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658012580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178294620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2115 S FREMONT AVE | ||||||||
| Address2: | SUITE 3050 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658042239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178203905 | ||||||||
| FaxNumber: | 4178203528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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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 | 207RI0200X | R2A37 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 1974 | 01 | COX HEALTH SYSTEMS | OTHER | 110527001 | 05 | AR | MEDICAID | 110193990 | 01 | RAILROAD MEDICARE | OTHER | 172643 | 01 | HEALTHLINK | OTHER | 18324 | 01 | BCBS | OTHER | 201203338 | 05 | MO | MEDICAID |