Provider Demographics
NPI:1396797932
Name:HAYWARD, LAWRENCE J (PA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:HAYWARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5807
Mailing Address - Country:US
Mailing Address - Phone:817-599-1200
Mailing Address - Fax:817-341-7351
Practice Address - Street 1:891 EUREKA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5807
Practice Address - Country:US
Practice Address - Phone:817-599-1200
Practice Address - Fax:817-341-7351
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00191075OtherMEDICARE RR IND. NUMBER
TX8N7980OtherBCBS IND. NUMBER
TX374432801Medicaid
TXPA04232OtherTEXAS STATE LICENSE NUMBE
TX8C9723Medicare ID - Type UnspecifiedMEDICARE IND. NUMBER