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General NPI Number Information
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NPI Number | 1912199746
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Entity Type | Organization
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Legal Business Name | HEATHER A HAYNES MD LLC
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 2265 HAYES AVE
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City | FREMONT
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State | OH
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Zip | 43420-2632
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Country | US
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Telephone | 419-333-8231
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Fax | 419-332-2553
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Provider Business Mailing Address
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Address Line | 2265 HAYES AVE
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City | FREMONT
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State | OH
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Zip | 43420-2632
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Country | US
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Telephone | 419-333-8231
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Fax | 419-332-2553
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEATHER ANN HAYNES
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Credential | M.D.
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Telephone | 419-333-8231
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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 | 35-090126
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License Number State | OH
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