Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 216 | AR |
N | 222Z00000X | Podiatrist | 216 | AR |
N | 213EP1101X | Primary Podiatric Medicine | 216 | AR |
N | 2081S0010X | Sports Medicine | 216 | AR |
N | 213ES0000X | Sports Medicine | 216 | AR |
Y | 213ES0103X | Foot & Ankle Surgery | 216 | AR |
NPI | 1346246352 |
---|---|
Provider Name | Dr. Walter Wadsworth Hayes |
First Address | Jonesboro, AR 72403-6711 |
Second Address | Jonesboro, AR 72401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149111717 | (05) | AR |
309032506 | (05) | MO |
5X147 | BLUE CROSS/ BLUE SHIELD (01) | AR |
BH8202296 | DEA NUMBER (01) | AR |
P00449141 | RAILROAD PTAN (01) | AR |
U92549 | (02) | AR |