Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | OR 12570 | OR |
NPI | 1033232996 |
---|---|
Provider Name | Dr. Jeffrey Benton Hayes |
First Address | Warren, OR 97053-9609 |
Second Address | Portland, OR 97214-1328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
223719 | (05) | OR |
C92837 | (02) | OR |