Provider Demographics
NPI:1861875239
Name:HAYES, JORDAN JEROME
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JEROME
Last Name:HAYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 DICKINSON AVE
Mailing Address - Street 2:APT. 213
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-8171
Mailing Address - Country:US
Mailing Address - Phone:641-202-2089
Mailing Address - Fax:
Practice Address - Street 1:905 DICKINSON AVE
Practice Address - Street 2:APT. 213
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-8171
Practice Address - Country:US
Practice Address - Phone:641-202-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program