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General NPI Number Information
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NPI Number | 1720473291
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Entity Type | Individual
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Provider Name | JAMES DOUGLAS HAYCOCK D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 12221 N MOPAC EXPY
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City | AUSTIN
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State | TX
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Zip | 78758-2401
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Country | US
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Telephone | 512-901-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 777 BANNOCK ST MC 0108
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City | DENVER
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State | CO
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Zip | 80204-4507
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Country | US
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Telephone | 303-602-5183
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DR.0059777
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | S0900
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License Number State | TX
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