Provider Demographics
NPI:1699732016
Name:HAYWARD, TAMARA L (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:SHUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:6401 HARRIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6101
Practice Address - Country:US
Practice Address - Phone:817-346-2525
Practice Address - Fax:817-294-1692
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3994208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2543095OtherAETNA
TX8G0490OtherBCBS
TX157933603Medicaid
TX10010633OtherAMERIGROUP
TX130900705OtherMEDICAID EPSDT
TX2543095OtherAETNA