Healthcare Provider Details

I. General information

NPI: 1629331921
Provider Name (Legal Business Name): JACOB ASHER HAYNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/22/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N LEE AVE STE 200
OKLAHOMA CITY OK
73103-2612
US

IV. Provider business mailing address

1110 N LEE AVE STE 200
OKLAHOMA CITY OK
73103-2612
US

V. Phone/Fax

Practice location:
  • Phone: 405-218-2530
  • Fax: 405-218-2535
Mailing address:
  • Phone: 405-218-2530
  • Fax: 405-218-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2012017902
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number33602
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: