Provider Demographics
NPI:1669815825
Name:HAYWARD, LAUREN DIANE (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DIANE
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:DIANE
Other - Last Name:ZERBIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 W FOREST AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1481
Mailing Address - Country:US
Mailing Address - Phone:928-214-3600
Mailing Address - Fax:
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1479
Practice Address - Country:US
Practice Address - Phone:928-214-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52202208000000X
CA134074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics