Provider Demographics
NPI:1528040060
Name:HAYES, DOUGLAS SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TAYLOR AVE
Mailing Address - Street 2:PO BOX K
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134
Mailing Address - Country:US
Mailing Address - Phone:540-921-6033
Mailing Address - Fax:540-921-6084
Practice Address - Street 1:1 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134
Practice Address - Country:US
Practice Address - Phone:540-921-6033
Practice Address - Fax:540-921-6084
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-12-27
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-12-27
Provider Licenses
StateLicense IDTaxonomies
VA0101-041283207Q00000X
VA0101041283207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB06342Medicare UPIN
VA001440C23Medicare ID - Type Unspecified