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General NPI Number Information
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NPI Number | 1760619027
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Entity Type | Individual
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Provider Name | JUSTIN HAYNES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 6451 BRENTWOOD STAIR RD #200
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City | FORT WORTH
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State | TX
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Zip | 76112-3200
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Country | US
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Telephone | 817-469-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 INDIAN SPGS HAYNES MEDICINE PLLC
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City | CARROLLTON
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State | TX
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Zip | 75007-6001
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Country | US
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Telephone | 252-412-5573
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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 | P9585
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License Number State | TX
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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 | 2012-01485
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License Number State | NC
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