Provider Demographics
NPI:1235133091
Name:HAYWARD, JAMES R (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HAYWARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0228
Mailing Address - Country:US
Mailing Address - Phone:740-380-8068
Mailing Address - Fax:740-380-2734
Practice Address - Street 1:819 STATE ROUTE 664 N
Practice Address - Street 2:STE A
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8540
Practice Address - Country:US
Practice Address - Phone:740-385-9614
Practice Address - Fax:740-380-2734
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002691H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000198892OtherUNISON
OH0365037Medicaid
OH0100639OtherUHC
OH000000120791OtherANTHEM
OH000000120791OtherANTHEM
OH0450357Medicare PIN
OH0365037Medicaid