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General NPI Number Information
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NPI Number | 1316116841
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Entity Type | Organization
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Legal Business Name | GRACE A HAYNES PC
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 4824 E BASELINE RD STE 140
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City | MESA
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State | AZ
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Zip | 85206
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Country | US
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Telephone | 480-505-3276
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Fax | 480-545-9594
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Provider Business Mailing Address
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Address Line | 4824 E BASELINE RD STE 140
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City | MESA
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State | AZ
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Zip | 85206-4680
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Country | US
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Telephone | 480-969-4040
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Fax | 480-830-1042
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GRACE ANDREA HAYNES
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Credential | MD
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Telephone | 480-505-3276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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