Healthcare Provider Details

I. General information

NPI: 1043656119
Provider Name (Legal Business Name): LAUREN MARIE HAYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 SOUTH GRAND BOULEVARD, ROOM 1204 SSM CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
ST. LOUIS MO
63104
US

IV. Provider business mailing address

1465 SOUTH GRAND BOULEVARD, ROOM 1204 SSM CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
ST. LOUIS MO
63104
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax: 314-577-5616
Mailing address:
  • Phone: 314-577-5600
  • Fax: 314-577-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016010180
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: