Provider Demographics
NPI:1588691125
Name:HADEN, JAMES RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:HADEN
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 1:1000 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3033
Mailing Address - Country:US
Mailing Address - Phone:817-336-8855
Mailing Address - Fax:817-336-4228
Practice Address - Street 1:1000 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3033
Practice Address - Country:US
Practice Address - Phone:817-336-8855
Practice Address - Fax:817-336-4228
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0234207K00000X, 207KA0200X, 207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143081103Medicaid
TX143081103Medicaid
TXH29144Medicare UPIN