Provider Demographics
NPI:1598970899
Name:HAIKES, BRENDON (MD)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:HAIKES
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 1:2022 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:STE. 313 ACC
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6808
Mailing Address - Country:US
Mailing Address - Phone:205-877-2910
Mailing Address - Fax:205-879-4649
Practice Address - Street 1:833 PRINCETON AVE SW
Practice Address - Street 2:POB III SUITE 200-A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1323
Practice Address - Country:US
Practice Address - Phone:205-786-3096
Practice Address - Fax:205-397-8132
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26462208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1598970899OtherNPI
AL1598970899Medicaid
AL1598970899OtherNPI