MEDICARE: DR. TRACY A. HAINES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	37147	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013676	OTHER		KAISER COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1316129356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY A. HAINES M.D.

Provider Business Mailing Address
First Line	:	4350 LIMELIGHT AVE STE 205
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-8034
Country	:	US
Telephone Number	:	720-686-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 LIMELIGHT AVE STE 205
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-8034
Country	:	US
Telephone Number	:	720-686-7546
Fax Number	:	720-686-7544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2007
Last Update Date	:	10/03/2024

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