Provider Demographics
NPI:1376558205
Name:HAINES, GREGORY ALAN (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:HAINES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11841 OWATONNA ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-3919
Mailing Address - Country:US
Mailing Address - Phone:763-205-6555
Mailing Address - Fax:
Practice Address - Street 1:11841 OWATONNA ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-3919
Practice Address - Country:US
Practice Address - Phone:763-205-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN396382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1376558205OtherDAKOTA CARE
MN415OtherAMERICA'S PPO
MN636518300Medicaid
WI43538000Medicaid
MN1604662OtherMEDICA
MN343C1HAOtherBLUE COSS AND BLUE SHIELD OF MN
MN61477HAOtherBLUE CROSS AND BLUE SHIELD OF MINNESOTA
MNHP25845OtherHEALTHPARTNERS
MN253016OtherMIDLANDS CHOICE INC
IA0762633Medicaid
MN124717OtherUCARE
MN960371014447OtherPREFERRED ONE
MNP00377639OtherRAILROAD MEDICARE MN
MN300004127Medicare PIN
IA0762633Medicaid
MNHP25845OtherHEALTHPARTNERS
MN253016OtherMIDLANDS CHOICE INC
MN61477HAOtherBLUE CROSS AND BLUE SHIELD OF MINNESOTA
MN415OtherAMERICA'S PPO