Provider Demographics
NPI:1710941919
Name:HAYES, JOHN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-0908
Mailing Address - Country:US
Mailing Address - Phone:918-426-0240
Mailing Address - Fax:918-423-4051
Practice Address - Street 1:1401 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4245
Practice Address - Country:US
Practice Address - Phone:918-426-0240
Practice Address - Fax:918-423-4051
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19314208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731310891028OtherTRICARE SOUTH
OK731310891006OtherUNICARE
OK0166707OtherUMWA
OK1324230001OtherPALMETTO DME
OK74502A019OtherCHAMPUS (WPS)
OKG02664OtherSTERLING OPTION 1
OK100154680AMedicaid
OK0166707OtherUMWA
OK731310891028OtherTRICARE SOUTH