Healthcare Provider Details

I. General information

NPI: 1013073873
Provider Name (Legal Business Name): JEFFREY CALEB HAYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVENUE
ROCHESTER NY
14621
US

IV. Provider business mailing address

1425 PORTLAND AVENUE
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4031
  • Fax: 585-922-2971
Mailing address:
  • Phone: 585-922-4031
  • Fax: 585-922-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMT184278
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number252834-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: