Provider Demographics
NPI:1861500274
Name:HAYNER, PAUL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL JOHN
Middle Name:
Last Name:HAYNER
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 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5618 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1208
Practice Address - Country:US
Practice Address - Phone:608-274-1100
Practice Address - Fax:608-833-6932
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53874207R00000X
ORMD24398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227403Medicaid
WA8371668Medicaid
WA8371668Medicaid
H66320Medicare UPIN
ORR135901Medicare PIN