Provider Demographics
NPI:1225128721
Name:HAYNES, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2251
Mailing Address - Country:US
Mailing Address - Phone:303-803-1005
Mailing Address - Fax:303-798-3248
Practice Address - Street 1:7720 S BROADWAY STE 540
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2635
Practice Address - Country:US
Practice Address - Phone:303-779-3013
Practice Address - Fax:303-779-0343
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89400780Medicaid
CO89400780Medicaid
5M202Medicare PIN