Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 9578 | TN |
NPI | 1003840406 |
---|---|
Provider Name | John Hayes |
First Address | Jackson, TN 38305-4436 |
Second Address | Jackson, TN 38301-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 24/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31963001 | (02) | TN |
3836240 | (05) | TN |
B04706 | (02) | TN |