Jack, Hayden O

Jack, Hayden O is an individual health care provider with primary practice located at 815 Pennsylvania Ave , Fort Worth TX 76104-2224. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Jack, Hayden O can be contacted via phone (817) 321-0387.

Contact Information

Primary practice address
815 Pennsylvania Ave Fort Worth TX 76104-2224
Phone: (817) 321-0387
Fax: (469) 522-6889
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 0101054381 Virginia
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X M8054 Texas
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X ME 113022 Florida

Profile Details

NPI number 1093795338
LBN Legal business name Jack, Hayden O
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 20th, 2006
Last updated Apr 28th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093795338 NPPES
Texas MEDICAID 121715004
Texas MEDICAID 121715008
Texas MEDICAID 285250101

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