Healthcare Provider Details

I. General information

NPI: 1447093620
Provider Name (Legal Business Name): SEAN PATRICK HAYES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 E ROSS ST
TAHLEQUAH OK
74464-0515
US

IV. Provider business mailing address

19500 E ROSS ST
TAHLEQUAH OK
74464-0515
US

V. Phone/Fax

Practice location:
  • Phone: 970-812-6246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0116042277
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: