Provider Demographics
NPI:1578956769
Name:HAYES, ROCKY (RT(R))
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 ENGLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5667
Mailing Address - Country:US
Mailing Address - Phone:503-347-9709
Mailing Address - Fax:
Practice Address - Street 1:3821 ENGLAND BLVD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5667
Practice Address - Country:US
Practice Address - Phone:503-347-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV461473247100000X
OR914564247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist