Healthcare Provider Details

I. General information

NPI: 1376533786
Provider Name (Legal Business Name): THOMAS W. HAYNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12780 WATERFORD LAKES PKWY STE 135
ORLANDO FL
32828-4501
US

IV. Provider business mailing address

12780 WATERFORD LAKES PKWY STE 135
ORLANDO FL
32828-4501
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-5888
  • Fax: 407-384-1136
Mailing address:
  • Phone: 407-380-5888
  • Fax: 407-384-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME78909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: