Healthcare Provider Details

I. General information

NPI: 1427357698
Provider Name (Legal Business Name): SAMUEL CARLTON HAYWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT ELIZABETH BLVD STE 3200
O FALLON IL
62269-1281
US

IV. Provider business mailing address

12855 N 40 DR STE 375
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 618-489-8030
  • Fax:
Mailing address:
  • Phone: 314-567-6071
  • Fax: 314-453-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036170078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: