Provider Demographics
NPI:1568874824
Name:HEAD, HAYDEN (MD)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAYDEN
Other - Middle Name:
Other - Last Name:ROAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:3203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7727
Practice Address - Country:US
Practice Address - Phone:903-266-4000
Practice Address - Fax:903-877-5080
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050113207Q00000X
TXR0585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX587636YMAFOtherMEDICARE
TX75-2616977-028OtherTRICARE
TXP01878872OtherMEDICARE RAIL ROAD
TX374159701OtherMEDICAID