Provider Demographics
NPI:1891735098
Name:HAYES, WILLIAM JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JUSTIN
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:JUSTIN
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:CHAFFEE CROSSING CLINIC
Mailing Address - City:HACKETT
Mailing Address - State:AR
Mailing Address - Zip Code:72937-0843
Mailing Address - Country:US
Mailing Address - Phone:479-434-6205
Mailing Address - Fax:479-434-6210
Practice Address - Street 1:11300 ROBERTS BLVD
Practice Address - Street 2:CHAFFEE CROSSING CLINIC
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916
Practice Address - Country:US
Practice Address - Phone:479-434-6205
Practice Address - Fax:479-434-6210
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3907207Q00000X
OK26119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155075001Medicaid
AR155075001Medicaid
AR155075001Medicaid