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1407867823

NPI Code Detail

MEDICARE: MRS. JEAN CAROL HAYES MD

MEDICARE: MRS. JEAN CAROL HAYES MD

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	207L00000X	Anesthesiology Physician	MD00034899	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HB143	OTHER		BLUE CROSS OF IDAHO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000010157589	OTHER		REGENCE BLUE SHIELD OF IDAHO

General Provider Information

NPI Number	:	1407867823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN CAROL HAYES MD

Provider Business Mailing Address
First Line	:	1221 HIGHLAND AVE
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2829
Country	:	US
Telephone Number	:	509-758-5511
Fax Number	:	509-751-9406

Provider Business Practice Location Address
First Line	:	1221 HIGHLAND AVE
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2829
Country	:	US
Telephone Number	:	509-758-5511
Fax Number	:	509-751-9406

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	05/16/2008

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Directions to “ MRS. JEAN CAROL HAYES MD” Practice Location

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