Healthcare Provider Details

I. General information

NPI: 1760619027
Provider Name (Legal Business Name): JUSTIN HAYNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SAINT FRANCIS AVE
WICHITA KS
67214-3821
US

IV. Provider business mailing address

1429 INDIAN SPGS HAYNES MEDICINE PLLC
CARROLLTON TX
75007-6001
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5000
  • Fax:
Mailing address:
  • Phone: 252-412-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2012-01485
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP9585
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: