Provider Demographics
NPI:1316069164
Name:HAYHURST, THOMAS ELDON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ELDON
Last Name:HAYHURST
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 1:200 E BERRY ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2731
Mailing Address - Country:US
Mailing Address - Phone:260-449-7578
Mailing Address - Fax:
Practice Address - Street 1:4813 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803-3018
Practice Address - Country:US
Practice Address - Phone:260-449-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01021495207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ01021495OtherSTATE MEDICAL LICENSE NO.