Provider Demographics
NPI:1609242791
Name:FREDDIE L. HAYES MD
Entity Type:Organization
Organization Name:FREDDIE L. HAYES MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-459-0127
Mailing Address - Street 1:302 FRESNO ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3600
Mailing Address - Country:US
Mailing Address - Phone:559-459-0127
Mailing Address - Fax:559-459-0129
Practice Address - Street 1:3702 E SAGINAW WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5123
Practice Address - Country:US
Practice Address - Phone:559-226-4971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC21598261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C215980Medicaid
CA00C215980Medicaid
CAA31964Medicare UPIN