Healthcare Provider Details

I. General information

NPI: 1235181504
Provider Name (Legal Business Name): BRUCE T HAYWARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MT HIGHWAY 91 S
DILLON MT
59725-7379
US

IV. Provider business mailing address

PO BOX 179 24 COACHMAN LN
MC ALLISTER MT
59740-0179
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-3000
  • Fax:
Mailing address:
  • Phone: 406-628-7459
  • Fax: 406-628-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0396
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8121
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: