Provider Demographics
NPI:1215021431
Name:C. DEXTER HAYES, MD, PC
Entity Type:Organization
Organization Name:C. DEXTER HAYES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL DEXTER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-649-0649
Mailing Address - Street 1:115 S CANDY LN
Mailing Address - Street 2:SUITE B2
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4105
Mailing Address - Country:US
Mailing Address - Phone:928-649-0649
Mailing Address - Fax:928-649-0486
Practice Address - Street 1:115 S CANDY LN
Practice Address - Street 2:SUITE B2
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4105
Practice Address - Country:US
Practice Address - Phone:928-649-0649
Practice Address - Fax:928-649-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146599Medicaid
AZ146599Medicaid
AZZMD20821Medicare ID - Type Unspecified