Organization
BRENT HAYDEN, M.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD BRENT HAYDEN M.D. (PRESIDENT)
(386) 755-0645
Entity
Organization
Contact information
Practice address
733 SW STATE ROAD 47, LAKE CITY, FL 32025-0453
(386) 755-0645
(386) 961-9541
Mailing address
733 SW STATE ROAD 47, LAKE CITY, FL 32025-0453
(386) 755-0645
(386) 961-9541
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041891900
—
FL
01
—
12066
MEDICARE ID-TYPE UNSPECIFIED
FL
01
—
ME0043394
STATE LICENCE NUMBER
FL
Enumeration date
10/05/2009
Last updated
12/18/2012
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