Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | PA9111383 | FL |
NPI | 1831676584 |
---|---|
Provider Name | Lukas Scott Hayden |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2018 |
Last Update Date | 25/07/2018 |