Healthcare Provider Details

I. General information

NPI: 1457307928
Provider Name (Legal Business Name): WALTER C HAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 231
ALTAMONTE SPRINGS FL
32701-5102
US

IV. Provider business mailing address

661 E ALTAMONTE DR STE 231
ALTAMONTE SPRINGS FL
32701-5102
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5214
  • Fax: 407-303-5215
Mailing address:
  • Phone: 407-303-5214
  • Fax: 407-303-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME86209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: