Provider Demographics
NPI:1447368576
Name:HAYWARD, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HAYWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1661 SOQUEL DR STE D
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1709
Practice Address - Country:US
Practice Address - Phone:831-458-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44296207R00000X
TXL1068207R00000X
CAC182225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040644906Medicaid
WIH29999OtherCIGNA
WI34216800Medicaid
WI390806395021OtherCHAMPUS
WI390806395027OtherTRICARE
TX040644905Medicaid
WI44296OtherTOUCHPOINT
TX040644903Medicaid
WI42239OtherNETWORK HEALTH PLAN
TX040644904Medicaid
WI100003091OtherWEA
WI110237969OtherRAILROAD MEDICARE
WI38235-0014Medicare ID - Type Unspecified
WI390806395027OtherTRICARE
WI110237969OtherRAILROAD MEDICARE
TXTXB155850Medicare PIN
WIH29999OtherCIGNA
WI42239OtherNETWORK HEALTH PLAN
TXP01060076Medicare PIN
TXTXB155849Medicare PIN