Provider Demographics
NPI:1760544795
Name:JAYNES, CHARLES R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:JAYNES
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 1:7610 W HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8231
Mailing Address - Country:US
Mailing Address - Phone:512-288-0859
Mailing Address - Fax:512-301-4821
Practice Address - Street 1:10828 W CAVE LOOP
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5078
Practice Address - Country:US
Practice Address - Phone:361-550-1545
Practice Address - Fax:267-393-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101960602Medicaid
TXTXB146895Medicare UPIN
TX101960602Medicaid
TX816559Medicare ID - Type Unspecified