Healthcare Provider Details

I. General information

NPI: 1205411261
Provider Name (Legal Business Name): MR. ZACHARY M HAYNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9399 CROWN CREST BLVD STE 220
PARKER CO
80138-8508
US

IV. Provider business mailing address

9399 CROWN CREST BLVD STE 220
PARKER CO
80138-8508
US

V. Phone/Fax

Practice location:
  • Phone: 303-805-1855
  • Fax: 303-805-4421
Mailing address:
  • Phone: 303-805-1855
  • Fax: 303-805-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0007482
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: