Provider Demographics
NPI:1437108289
Name:HAYFORD, DANIEL ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROSS
Last Name:HAYFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:R
Other - Last Name:HAYFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:777 BEACHWAY DRIVE, SUITE 210
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224
Mailing Address - Country:US
Mailing Address - Phone:317-387-4219
Mailing Address - Fax:317-293-3991
Practice Address - Street 1:777 BEACHWAY DRIVE, SUITE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224
Practice Address - Country:US
Practice Address - Phone:317-293-7177
Practice Address - Fax:317-293-3991
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062065A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1437108289OtherNPI, INDIVIDUAL
IN202140Medicaid
IN1316128614OtherNPI, IIP GROUP
IN200826760Medicaid
IN000000544431OtherANTHEM, IIP
IN000000482970OtherANTHEM