Provider Demographics
NPI:1346246352
Name:HAYES, WALTER WADSWORTH (DPM)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WADSWORTH
Last Name:HAYES
Suffix:
Gender:M
Credentials:DPM
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 16712
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 WINDOVER
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-934-8200
Practice Address - Fax:870-934-8219
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216213E00000X, 213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO309032506Medicaid
AR5X147OtherBLUE CROSS/ BLUE SHIELD
ARP00449141OtherRAILROAD PTAN
AR149111717Medicaid
AR149111717Medicaid
ARBH8202296OtherDEA NUMBER
ARP00449141OtherRAILROAD PTAN