Provider Demographics
NPI:1154492155
Name:HAYMON, AVA CARROLL (MD)
Entity Type:Individual
Prefix:DR
First Name:AVA
Middle Name:CARROLL
Last Name:HAYMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:CARROLL
Other - Last Name:HAYMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:306 23RD AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2371
Mailing Address - Country:US
Mailing Address - Phone:206-518-9058
Mailing Address - Fax:
Practice Address - Street 1:306 23RD AVE S STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2371
Practice Address - Country:US
Practice Address - Phone:206-518-9058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041490207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154492155Medicaid