Provider Demographics
NPI:1780719062
Name:HAYDEN, GOULD DWIGHT (MD)
Entity type:Individual
Prefix:MR
First Name:GOULD
Middle Name:DWIGHT
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 SYLVA LN
Mailing Address - Street 2:STE.G
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-2020
Mailing Address - Fax:209-532-1687
Practice Address - Street 1:940 SYLVA LN
Practice Address - Street 2:STE.G
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-2020
Practice Address - Fax:209-532-1687
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC20960207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110900OtherEYEMED VISION PLAN
CA00C209601OtherSECOND MEDI-CAL PIN
CA00C209600Medicaid
CA1299310001OtherDMERC NORIDIAN
CAA88757Medicare UPIN
CA00C209601OtherSECOND MEDI-CAL PIN