Provider Demographics
NPI:1952341141
Name:HADDY, STEVEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:HADDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-7400
Mailing Address - Fax:323-442-7411
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-7400
Practice Address - Fax:323-442-7411
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG36992207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG36992CMedicare ID - Type Unspecified
CA00G369920OtherBLUE SHIELD
A91842Medicare UPIN
CA00G369920328OtherCALOPTIMA
CA00G369920Medicaid