Provider Demographics
NPI:1114417292
Name:HAYES, SOPHIA A
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:A
Last Name:HAYES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:ANNE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2330 NW BELGRAVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-1223
Mailing Address - Country:US
Mailing Address - Phone:971-413-3917
Mailing Address - Fax:
Practice Address - Street 1:1111 NE 99TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9442
Practice Address - Country:US
Practice Address - Phone:503-963-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61144353207R00000X, 207RC0200X, 207RP1001X
ORMD222939207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease