Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 17510 | AL |
N | 208D00000X | General Practice Physician | 17510 | AL |
NPI | 1043263536 |
---|---|
Provider Name | Walter George Haynes III |
First Address | Birmingham, AL 35283-0230 |
Second Address | Birmingham, AL 35209-6862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 24/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000033398 | (05) | AL |
F72248 | (02) | AL |