Healthcare Provider Details

I. General information

NPI: 1144576224
Provider Name (Legal Business Name): TREVOR J HAYNES D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37569 HIGHWAY 26
SANDY OR
97055-9301
US

IV. Provider business mailing address

2722 BRONZE LOQUATE CT
KATY TX
77449-5668
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5210
  • Fax: 877-480-9759
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP185979
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: