Active NPI
Robert Davis Haynie, MD
- Pediatrics Physician
- Shreveport, LA
National Provider Identifier
1174529630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 017143
- Practice address
- 2225 Line Ave
Shreveport, LA 71104-2128 - Phone
- (318) 221-2225
- Fax
- (318) 459-2955
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 017143 | LA | Primary |
Addresses
Primary practice location
2225 Line Ave
Shreveport, LA 71104-2128
Mailing address
2225 Line Ave
Shreveport, LA 71104-2128
Phone (318) 221-2225
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| I1377741 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017143 | LA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid City Pediatrics | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1174529630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2225 LINE AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711042128",
"telephone_number": "318-221-2225",
"fax_number": "318-459-2955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2225 LINE AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711042128",
"telephone_number": "318-221-2225",
"fax_number": "318-459-2955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYNIE",
"first_name": "ROBERT",
"middle_name": "DAVIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "LA",
"license": "017143",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "I1377741",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.