Healthcare Provider Details

I. General information

NPI: 1568460129
Provider Name (Legal Business Name): GREGORY L HAYDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE SUITE 320
EVANSVILLE IN
47714-0100
US

IV. Provider business mailing address

PO BOX 722
HENDERSON KY
42419-0722
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-3937
  • Fax: 812-477-9797
Mailing address:
  • Phone: 812-477-3937
  • Fax: 812-477-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01043538
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: