Provider Demographics
NPI:1982640942
Name:HAYES, RANDALL E (DO)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:E
Last Name:HAYES
Suffix:
Gender:M
Credentials:DO
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 24299
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-1299
Mailing Address - Country:US
Mailing Address - Phone:817-510-9510
Mailing Address - Fax:817-799-0866
Practice Address - Street 1:451 WESTPARK WAY
Practice Address - Street 2:SUITE #1
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3703
Practice Address - Country:US
Practice Address - Phone:817-510-9510
Practice Address - Fax:817-799-0866
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091809604Medicaid
TXP00642502OtherRAILROAD MEDICARE
TX8M6413OtherBCBS
TX091809604Medicaid
TX8L0842Medicare PIN
TXD97387Medicare UPIN