Provider Demographics
NPI:1104812338
Name:HAYES, CLINT A (MD)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:A
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 1:1325 N TRAVIS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5138
Mailing Address - Country:US
Mailing Address - Phone:903-893-0123
Mailing Address - Fax:855-461-7801
Practice Address - Street 1:1325 N TRAVIS ST STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5138
Practice Address - Country:US
Practice Address - Phone:903-893-0123
Practice Address - Fax:855-461-7801
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8204202K00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172614301Medicaid
8C0943Medicare PIN
TX172614301Medicaid