=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235181504
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRUCE T HAYWARD DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 10/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 MT HIGHWAY 91 S
-----------------------------------------------------
City | DILLON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59725-7379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-683-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 179 24 COACHMAN LN
-----------------------------------------------------
City | MC ALLISTER
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59740-0179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-628-7459
-----------------------------------------------------
Fax | 406-628-4418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | O-0396
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 8121
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------