Provider Demographics
NPI:1235102963
Name:HAYNES, DOUGLAS BRANDT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BRANDT
Last Name:HAYNES
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 1:207 OAK PARK
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1336
Mailing Address - Country:US
Mailing Address - Phone:931-473-9624
Mailing Address - Fax:931-473-7718
Practice Address - Street 1:207 OAK PARK
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1336
Practice Address - Country:US
Practice Address - Phone:931-473-9624
Practice Address - Fax:931-473-7718
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10334207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3191762Medicaid
TN3384004Medicaid
TN3191762Medicaid
TNB04484Medicare UPIN
TN3191762Medicare ID - Type UnspecifiedINDIVIDUAL