Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD00010160 | WA |
NPI | 1073955548 |
---|---|
Provider Name | James Manley Haynes |
First Address | Hood River, OR 97031-2234 |
Second Address | Hood River, OR 97031-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 24/07/2013 |