Provider Demographics
NPI:1528149234
Name:HAYES, LARRY D (DPM)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:HAYES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:L
Other - Middle Name:D
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:714 N HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4510
Mailing Address - Country:US
Mailing Address - Phone:972-223-3266
Mailing Address - Fax:972-230-2368
Practice Address - Street 1:5584 N SHILOH RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6614
Practice Address - Country:US
Practice Address - Phone:214-210-2911
Practice Address - Fax:214-210-2209
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0914213ES0103X
TX914213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112218603Medicaid
TX112218605Medicaid
TX480006708OtherRAILROAD MEDICARE
TX5004780001Medicare NSC
TX00GK36Medicare PIN