Basic Information
| Provider Information | |||||||||
| NPI: | 1710941919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 908 | ||||||||
| Address2: | |||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745020908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184260240 | ||||||||
| FaxNumber: | 9184234051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 E VAN BUREN AVE | ||||||||
| Address2: | |||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745014245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184260240 | ||||||||
| FaxNumber: | 9184234051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 04/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 19314 | OK | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 731310891028 | 01 | OK | TRICARE SOUTH | OTHER | 731310891006 | 01 | OK | UNICARE | OTHER | 0166707 | 01 | OK | UMWA | OTHER | 1324230001 | 01 | OK | PALMETTO DME | OTHER | 74502A019 | 01 | OK | CHAMPUS (WPS) | OTHER | G02664 | 01 | OK | STERLING OPTION 1 | OTHER | 100154680A | 05 | OK | MEDICAID |