Provider Demographics
NPI:1659305944
Name:HAYES, RONALD L (PAC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:HAYES
Suffix:
Gender:M
Credentials:PAC
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 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 E JEFFERSON ST STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5643
Practice Address - Country:US
Practice Address - Phone:206-320-7300
Practice Address - Fax:206-320-4698
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004659363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8391187Medicaid
8802811Medicare ID - Type UnspecifiedNORIDIAN
S88440Medicare UPIN