Provider Demographics
NPI:1144288788
Name:HAYDON, JOHN R JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:HAYDON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:14537 W INDIAN SCHOOL RD
Mailing Address - Street 2:700
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-935-0247
Mailing Address - Fax:623-935-2209
Practice Address - Street 1:14537 W INDIAN SCHOOL RD
Practice Address - Street 2:700
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-935-0247
Practice Address - Fax:623-935-2209
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-11-28
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Provider Licenses
StateLicense IDTaxonomies
AZ28948207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4336034OtherAETNA
AZ070015600OtherRAILROAD MEDICARE
AZ610071Medicaid
AZAZ0885120OtherBLUE CROSS BLUE SHIELD
AZ2087057OtherUNITED HEALTHCARE
AZ1Z5865OtherHEALTH NET
AZ1467402933OtherGROUP NPI
AZ188961600OtherDEPT OF LABOR WORK COMP
AZ1144288788OtherAHCCCS
AZ99S0070000010OtherMEDISUN
AZ4336034OtherAETNA
AZ64811Medicare PIN
AZ1Z5865OtherHEALTH NET