Provider Demographics
NPI:1023039815
Name:EUBANKS, HAYWARD LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAYWARD
Middle Name:LYNN
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4477 W 118TH ST
Mailing Address - Street 2:SUITE# 205
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2255
Mailing Address - Country:US
Mailing Address - Phone:310-679-0676
Mailing Address - Fax:310-679-0087
Practice Address - Street 1:5529 SECREST DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2029
Practice Address - Country:US
Practice Address - Phone:323-296-3431
Practice Address - Fax:310-679-0087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG54388207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93297Medicare UPIN