Provider Demographics
NPI:1710444831
Name:POULSON, HAYDEN VERL (DPM)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:VERL
Last Name:POULSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:866-974-2673
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:1485 N TURQUOISE DR STE 200
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2000
Practice Address - Country:US
Practice Address - Phone:928-226-2900
Practice Address - Fax:928-226-3071
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11154868-0501213ES0103X
AZPOD-000953213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery