Healthcare Provider Details

I. General information

NPI: 1386690980
Provider Name (Legal Business Name): DOUGLAS J. HAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E COOLEY DR
COLTON CA
92324-3905
US

IV. Provider business mailing address

PO BOX 2200
REDLANDS CA
92373-0722
US

V. Phone/Fax

Practice location:
  • Phone: 909-370-4100
  • Fax: 909-796-4158
Mailing address:
  • Phone: 909-793-3311
  • Fax: 909-796-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG47396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: