Healthcare Provider Details

I. General information

NPI: 1902836588
Provider Name (Legal Business Name): DOUGLAS HAYDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S SCHEUBER RD
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

167 GOLD CREEK DR
CHEHALIS WA
98532-9000
US

V. Phone/Fax

Practice location:
  • Phone: 360-748-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00019959
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00019959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: