Healthcare Provider Details

I. General information

NPI: 1578956769
Provider Name (Legal Business Name): ROCKY HAYES R.T.(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 ENGLAND BLVD
MISSOULA MT
59808-5667
US

IV. Provider business mailing address

3821 ENGLAND BLVD
MISSOULA MT
59808-5667
US

V. Phone/Fax

Practice location:
  • Phone: 503-347-9709
  • Fax:
Mailing address:
  • Phone: 503-347-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number461473
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number914564
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: