Healthcare Provider Details

I. General information

NPI: 1679578587
Provider Name (Legal Business Name): JOSEPH MICHAEL HAYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 FRANKLIN RD SW
ROANOKE VA
24016-4606
US

IV. Provider business mailing address

1234 FRANKLIN RD SW
ROANOKE VA
24016-4606
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-1561
  • Fax: 540-345-2112
Mailing address:
  • Phone: 540-345-1561
  • Fax: 540-345-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR0063085
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101032283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: