Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME87264 | FL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME87264 | FL |
NPI | 1407826662 |
---|---|
Provider Name | Dr. Brian E Haycook |
First Address | St Augustine, FL 32086-4202 |
Second Address | St Augustine, FL 32086-4202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 27/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174540001 | DMERC (01) | FL |
1174540001 | DMERC CIGNA GOVT SVCS (01) | FL |
H63663 | (02) | FL |