Provider Demographics
NPI:1295746055
Name:HAYMAN, BRAD L (DPM)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:L
Last Name:HAYMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 CLEARWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7165
Mailing Address - Country:US
Mailing Address - Phone:928-776-9428
Mailing Address - Fax:928-776-9214
Practice Address - Street 1:3103 CLEARWATER DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7165
Practice Address - Country:US
Practice Address - Phone:928-776-9428
Practice Address - Fax:928-776-9214
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ216213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102434Medicaid
AZ102434Medicaid
AZ6157070001Medicare NSC
AZZ73024Medicare PIN
AZZ113433Medicare PIN