Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12009019 | IN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 12009019 | IN |
NPI | 1386791580 |
---|---|
Provider Name | David L Hayhurst |
First Address | Evansville, IN 47710-1614 |
Second Address | Evansville, IN 47710-1614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 10/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100246120 | (05) | IN |
U63654 | (02) | IN |