Provider Demographics
NPI:1760794705
Name:HAYES, DONNELL JR
Entity Type:Individual
Prefix:
First Name:DONNELL
Middle Name:
Last Name:HAYES
Suffix:JR
Gender:M
Credentials:
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 322
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-0322
Mailing Address - Country:US
Mailing Address - Phone:405-410-2304
Mailing Address - Fax:
Practice Address - Street 1:500 N MERIDIAN AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5700
Practice Address - Country:US
Practice Address - Phone:405-410-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor