Healthcare Provider Details

I. General information

NPI: 1164586830
Provider Name (Legal Business Name): GARY LYNN HAYS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S 30TH ST
CLINTON OK
73601-3631
US

IV. Provider business mailing address

540 S 30TH ST
CLINTON OK
73601-3631
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-4141
  • Fax: 580-323-5065
Mailing address:
  • Phone: 580-323-4141
  • Fax: 580-323-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2095
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: