Provider Demographics
NPI:1366648834
Name:HAYNES, JAMIE L (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:STOP 8143
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0002
Mailing Address - Country:US
Mailing Address - Phone:806-743-2775
Mailing Address - Fax:806-743-1421
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:STOP 8143
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2757
Practice Address - Fax:806-743-1180
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1345207Q00000X
WAMD00046932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine