MEDICARE: DR. RUSSELL BENNETT HAYS JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A54728	CA

General Provider Information

NPI Number	:	1164409165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL BENNETT HAYS JR. M.D.

Provider Business Mailing Address
First Line	:	4116 W POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-225-1212
Fax Number	:	619-225-1726

Provider Business Practice Location Address
First Line	:	4116 W POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-225-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	06/20/2022

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