Provider Demographics
NPI:1578679809
Name:HADEN, JAMES BYRD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BYRD
Last Name:HADEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1416 E A ST # S101
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2276
Mailing Address - Country:US
Mailing Address - Phone:307-577-8600
Mailing Address - Fax:307-577-8605
Practice Address - Street 1:1416 E A ST # S101
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2276
Practice Address - Country:US
Practice Address - Phone:307-577-8600
Practice Address - Fax:307-577-8605
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18505208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17301572Medicaid
WY102577500Medicaid
WY102577500Medicaid
CO17301572Medicaid
D33528Medicare UPIN