Provider Demographics
NPI:1003886524
Name:HAYES, ROBERT E (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HAYES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 EASTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46017-9689
Mailing Address - Country:US
Mailing Address - Phone:765-378-7306
Mailing Address - Fax:765-378-7306
Practice Address - Street 1:3111 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4371
Practice Address - Country:US
Practice Address - Phone:765-284-0879
Practice Address - Fax:765-284-1480
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090015A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN209020LMedicare ID - Type Unspecified
INS00941Medicare UPIN