Provider Demographics
NPI:1083672778
Name:HAYNIE, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:HAYNIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-221-5965
Mailing Address - Fax:972-436-0351
Practice Address - Street 1:4214 ANDREWS HWY STE 109
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4822
Practice Address - Country:US
Practice Address - Phone:432-221-2200
Practice Address - Fax:432-221-3595
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5159207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060056587OtherRAILROAD MEDICARE
TX86T912OtherBLUE CROSS BLUE SHIELD
TX131682005Medicaid
TX060056587OtherRAILROAD MEDICARE
TX86T912OtherBLUE CROSS BLUE SHIELD
TXC66047Medicare UPIN