Provider Demographics
NPI:1003361742
Name:HAYNIE, CALEB JAMES SR (IDC)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:JAMES
Last Name:HAYNIE
Suffix:SR
Gender:M
Credentials:IDC
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Mailing Address - Street 1:3423 GUADALCANAL RD BLDG 401 2ND DECK
Mailing Address - Street 2:SEAL TEAM SEVENTEEN
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5599
Mailing Address - Country:US
Mailing Address - Phone:619-537-1334
Mailing Address - Fax:619-437-2068
Practice Address - Street 1:3423 GUADALCANAL RD BLDG 401 2ND DECK
Practice Address - Street 2:SEAL TEAM SEVENTEEN
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92155-5599
Practice Address - Country:US
Practice Address - Phone:619-537-1334
Practice Address - Fax:619-437-2068
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman