Provider Demographics
NPI:1770766875
Name:HAYES, MARY JOSEPHA (MAOM)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOSEPHA
Last Name:HAYES
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2011 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3947
Mailing Address - Country:US
Mailing Address - Phone:352-281-8998
Mailing Address - Fax:
Practice Address - Street 1:808 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3534
Practice Address - Country:US
Practice Address - Phone:352-281-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2490171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist