Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD25709 | TN |
NPI | 1306839360 |
---|---|
Provider Name | Daniel F Haynes |
First Address | Mountain Home, TN 37684-0699 |
Second Address | Johnson City, TN 37604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B64498 | (02) |