Healthcare Provider Details

I. General information

NPI: 1700975174
Provider Name (Legal Business Name): JOHN HAYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 MOUNT HOOD AVENUE
WOODBURN OR
97071
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-2000
  • Fax: 503-982-0660
Mailing address:
  • Phone: 509-865-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD26120
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: