Healthcare Provider Details

I. General information

NPI: 1730591272
Provider Name (Legal Business Name): ANDREW HAYNES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDY HAYNES D.O

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3987
  • Fax:
Mailing address:
  • Phone: 707-423-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02004739A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number02004739A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: