Provider Demographics
NPI:1235181504
Name:HAYWARD, BRUCE T (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:T
Last Name:HAYWARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:24 COACHMAN LN
Mailing Address - City:MC ALLISTER
Mailing Address - State:MT
Mailing Address - Zip Code:59740-0179
Mailing Address - Country:US
Mailing Address - Phone:406-628-7459
Mailing Address - Fax:406-628-4418
Practice Address - Street 1:600 MT HIGHWAY 91 S
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-7379
Practice Address - Country:US
Practice Address - Phone:406-683-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0396207Q00000X
MT8121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3503279Medicaid
271335Medicare ID - Type Unspecified
MT3503279Medicaid