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General NPI Number Information
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NPI Number | 1376558205
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Entity Type | Individual
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Provider Name | GREGORY ALAN HAINES D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 7595 ANAGRAM DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7399
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Country | US
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Telephone | 612-573-2200
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Fax | 612-573-2274
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Provider Business Mailing Address
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Address Line | 7595 ANAGRAM DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7399
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Country | US
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Telephone | 612-573-2200
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Fax | 612-573-2274
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 39638
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2012-00617
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License Number State | NC
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