# BRENT HAYDEN, M.D.,P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326373606
- **Authorized official:** DR. DONALD BRENT HAYDEN M.D. (PRESIDENT)
- **Authorized official phone:** (386) 755-0645

## Contact information

- **Practice address:** 733 SW STATE ROAD 47, LAKE CITY, FL 32025-0453
- **Practice address phone:** (386) 755-0645
- **Practice address fax:** (386) 961-9541
- **Mailing address:** 733 SW STATE ROAD 47, LAKE CITY, FL 32025-0453
- **Mailing address phone:** (386) 755-0645
- **Mailing address fax:** (386) 961-9541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/05/2009
- **Last updated:** 12/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 041891900 | — | FL |
| 01 | — | 12066 | MEDICARE ID-TYPE UNSPECIFIED | FL |
| 01 | — | ME0043394 | STATE LICENCE NUMBER | FL |