Provider Demographics
NPI:1750444931
Name:HAIDINYAK, JOHN GEORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GEORGE
Last Name:HAIDINYAK
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 1:1329 N UNIVERSITY DR SUITE E1
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961
Mailing Address - Country:US
Mailing Address - Phone:936-564-9164
Mailing Address - Fax:936-560-2538
Practice Address - Street 1:4920 NORTHEAST STALLINGS DRIVE
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-569-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDFS222207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF5222OtherCOM
TX88430XOtherBLUECROSS
TX8AT728OtherBCBS
TX110255004Medicaid
TX110255002Medicaid
TX110255002Medicaid
TX110255004Medicaid
TX88430XOtherBLUECROSS