=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639599079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNE G HAYES DERMATOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2014
-----------------------------------------------------
Last Update Date | 04/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 HAMMILL LN
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89511-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-332-0300
-----------------------------------------------------
Fax | 775-332-0311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 HAMMILL LN
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89511-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-332-0300
-----------------------------------------------------
Fax | 775-332-0311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANNE G HAYES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 775-332-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 6879
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------