Provider Demographics
NPI:1700867827
Name:HAYES, RICHARD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
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 358
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-0358
Mailing Address - Country:US
Mailing Address - Phone:765-675-8259
Mailing Address - Fax:765-675-8527
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-1772
Practice Address - Fax:317-988-5351
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054707A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200348410Medicaid
IN000000572680OtherANTHEM
IN000000572680OtherANTHEM
IN256870AMedicare PIN