Healthcare Provider Details

I. General information

NPI: 1104092717
Provider Name (Legal Business Name): JOSEPH REID HAYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2008
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST STE 400
SPRINGFIELD MO
65807-5179
US

IV. Provider business mailing address

1001 E PRIMROSE ST
SPRINGFIELD MO
65807-7006
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-7900
  • Fax: 417-269-7990
Mailing address:
  • Phone: 417-875-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR1415
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: