Healthcare Provider Details

I. General information

NPI: 1982671954
Provider Name (Legal Business Name): ERIC R HAYNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 US HIGHWAY 19 STE 102
NEW PORT RICHEY FL
34652-4260
US

IV. Provider business mailing address

4807 US HIGHWAY 19 STE 102
NEW PORT RICHEY FL
34652-4260
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-7618
  • Fax: 727-849-7090
Mailing address:
  • Phone: 727-846-7618
  • Fax: 727-849-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME0057444
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME0057444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: