Provider Demographics
NPI:1154491579
Name:HAYSE, BRUCE (M D)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:HAYSE
Suffix:
Gender:M
Credentials:M D
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 1884
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1884
Mailing Address - Country:US
Mailing Address - Phone:307-733-6700
Mailing Address - Fax:307-739-8890
Practice Address - Street 1:269 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-1884
Practice Address - Country:US
Practice Address - Phone:307-733-6700
Practice Address - Fax:307-739-8890
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3433A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY302273OtherBLUE CROSS BLUE SHIELD
WY4108719Medicare ID - Type Unspecified
WY302273OtherBLUE CROSS BLUE SHIELD