Healthcare Provider Details

I. General information

NPI: 1447412069
Provider Name (Legal Business Name): SHELBI RENEE HAYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 MIDTOWN PLACE
MIDWEST CITY OK
73130
US

IV. Provider business mailing address

1622 MIDTOWN PLACE
MIDWEST CITY OK
73130-5266
US

V. Phone/Fax

Practice location:
  • Phone: 405-280-7546
  • Fax: 405-772-8674
Mailing address:
  • Phone: 405-280-7546
  • Fax: 405-772-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number28831
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: