Individual
DR. WALLACE J HAYASAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
915 HIGHLAND BLVD, BOZEMAN, MT 59715-6902
(602) 262-8900
(602) 262-4132
Mailing address
PO BOX 84891, SEATTLE, WA 98124-6191
(406) 414-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
38727
CO
207L00000X
Anesthesiology Physician
52953
AZ
207L00000X
Anesthesiology Physician
Primary
57767
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26353580
—
CO
Enumeration date
12/14/2005
Last updated
12/15/2020
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