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General NPI Number Information
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NPI Number | 1629437546
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Entity Type | Individual
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Provider Name | BRET COLTER HAINES D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 620 S MADISON ST STE 108
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City | ENID
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State | OK
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Zip | 73701-7270
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Country | US
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Telephone | 580-977-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 620 S MADISON ST STE 108
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City | ENID
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State | OK
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Zip | 73701-7270
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Country | US
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Telephone | 580-977-1901
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 6176
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License Number State | OK
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