Provider Demographics
NPI:1154492155
Name:HAYMON, AVA CARROLL (MD)
Entity type:Individual
Prefix:DR
First Name:AVA
Middle Name:CARROLL
Last Name:HAYMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:CARROLL
Other - Last Name:HAYMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 EMBARCADERO CTR FL 19
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:1414 S 324TH ST STE B207
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8444
Practice Address - Country:US
Practice Address - Phone:253-220-3121
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101204207Q00000X
WAMD00041490207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154492155Medicaid