Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 27823 | AZ |
NPI | 1255569976 |
---|---|
Provider Name | Dr. Beth Ann Haynes |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 08/02/2013 |