Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D7987 | MN |
NPI | 1104836709 |
---|---|
Provider Name | Gary W Hayes |
First Address | Winona, MN 55987-4868 |
Second Address | Winona, MN 55987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 20/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
582518100 | (05) | MN |
T39318 | (02) |