Provider Demographics
NPI:1609938893
Name:HAYCRAFT, DANIEL MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARTIN
Last Name:HAYCRAFT
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 1:913 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-1433
Mailing Address - Country:US
Mailing Address - Phone:707-942-6233
Mailing Address - Fax:707-942-6382
Practice Address - Street 1:913 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CALISTOGA
Practice Address - State:CA
Practice Address - Zip Code:94515-1433
Practice Address - Country:US
Practice Address - Phone:707-942-0844
Practice Address - Fax:707-942-6382
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-1011442084P0800X
CAC560752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC56075OtherCALIFORNIA MEDICAL LICENSE
IL01627888OtherBLUE CROSS
IL036101144Medicaid
IL036-101144OtherILLINOIS MEDICAL LICENSE
IL36-4483763OtherTIN
IL036-101144OtherILLINOIS MEDICAL LICENSE
IL36-4483763OtherTIN