MEDICARE: BRUCE HAYSE M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	3433A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	302273	OTHER	WY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1154491579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE HAYSE M. D.

Provider Business Mailing Address
First Line	:	PO BOX 1884
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-1884
Country	:	US
Telephone Number	:	307-733-6700
Fax Number	:	307-739-8890

Provider Business Practice Location Address
First Line	:	269 WEST BROADWAY
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-1884
Country	:	US
Telephone Number	:	307-733-6700
Fax Number	:	307-739-8890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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Directions to “ BRUCE HAYSE M. D.” Practice Location

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