Provider Demographics
NPI:1356328280
Name:HAYES, ELIZABETH JO (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JO
Last Name:HAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000244602085N0700X, 2085R0202X
IDM-123902085N0700X, 2085R0202X
AKS-60372085R0202X, 2085N0700X
MI43010403732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1356328280Medicaid
WA0390462OtherL&I-RADIA KING COUNTY
WA0390463OtherL&I-SWEDISH RADIA EDMONDS
WA8144495Medicaid
WA0202412OtherL&I-EVERGREEN RADIA
WA0115848OtherL&I-RADIA REST OF WA
AK1613114Medicaid
WA115848OtherLNI PROVIDER ID
WA8144495Medicaid
WAGAB02919Medicare PIN
WAP00314944Medicare PIN
WAG8857102Medicare PIN
WA202412OtherLNI PROVIDER ID
WAGAB03740Medicare PIN
WAP00368464Medicare PIN
WAB97229Medicare UPIN
ID20004904Medicare PIN