Provider Demographics
NPI:1922519974
Name:HAYES, BRYCE EDWARDS
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:EDWARDS
Last Name:HAYES
Suffix:
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 1:16568 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7338
Mailing Address - Country:US
Mailing Address - Phone:903-617-8800
Mailing Address - Fax:
Practice Address - Street 1:16568 KINGSTON CT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7338
Practice Address - Country:US
Practice Address - Phone:903-617-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications