Provider Demographics
NPI:1609861897
Name:HAYHURST, RUSSELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:A
Last Name:HAYHURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W 38TH ST
Mailing Address - Street 2:STE 303
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1163
Mailing Address - Country:US
Mailing Address - Phone:512-452-8467
Mailing Address - Fax:512-452-8440
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:STE 303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1163
Practice Address - Country:US
Practice Address - Phone:512-452-8467
Practice Address - Fax:512-452-8440
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9216207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154994101Medicaid
TX4494050OtherAETNA
TX3471181OtherCIGNA
TX180046326OtherRAILROAD MEDICARE
TX8AB070OtherBCBS
TXF82373Medicare UPIN
TX8A0474Medicare PIN