Provider Demographics
NPI:1467427666
Name:HAYNIE, WILLIAM W (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
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 1:706 S HIGH
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-0370
Mailing Address - Country:US
Mailing Address - Phone:660-200-7135
Mailing Address - Fax:660-200-7015
Practice Address - Street 1:706 S HIGH
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-0370
Practice Address - Country:US
Practice Address - Phone:660-200-7135
Practice Address - Fax:660-200-7015
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200473007Medicaid
MO6030739Medicare Oscar/Certification
MO200473007Medicaid
3130739Medicare ID - Type Unspecified