Individual
PAUL KEVIN HIATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
18952
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-02702
UNITED HEALTHCARE
NC
01
—
42101
BLUE CROSS BLUE SHIELD
NC
05
—
8942101
—
NC
Enumeration date
08/09/2005
Last updated
11/02/2012
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