Healthcare Provider Details

I. General information

NPI: 1427042340
Provider Name (Legal Business Name): WILLIAM A HAYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 11/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9611 ARBOR CT
LANTANA TX
76226-6426
US

IV. Provider business mailing address

9611 ARBOR CT
LANTANA TX
76226-6426
US

V. Phone/Fax

Practice location:
  • Phone: 940-725-0022
  • Fax:
Mailing address:
  • Phone: 940-725-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberJ3116
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: