Provider Demographics
NPI:1427097450
Name:HADDEN, DOUGLAS L (PA-C)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:L
Last Name:HADDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NE
Mailing Address - Zip Code:69336-0520
Mailing Address - Country:US
Mailing Address - Phone:308-262-1755
Mailing Address - Fax:308-262-0765
Practice Address - Street 1:1320 S ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-2563
Practice Address - Country:US
Practice Address - Phone:308-262-1755
Practice Address - Fax:308-262-0765
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE681363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES79913Medicare UPIN