Provider Demographics
NPI:1083783633
Name:LEWIS, HAYDEN L SR (MD)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:L
Last Name:LEWIS
Suffix:SR
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 1:1 CALIFORNIA ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5424
Mailing Address - Country:US
Mailing Address - Phone:800-997-6196
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:1 CALIFORNIA ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5424
Practice Address - Country:US
Practice Address - Phone:800-997-6196
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7329207Q00000X
LA311667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185557903Medicaid
TX185557901Medicaid
TXTXB122007Medicare PIN
TX8J4030Medicare PIN
TX185557903Medicaid