Provider Demographics
NPI:1932318763
Name:HAYNES, TIMOTHY FRANKLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FRANKLIN
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BEACH
Mailing Address - State:TX
Mailing Address - Zip Code:77650-1200
Mailing Address - Country:US
Mailing Address - Phone:409-684-1020
Mailing Address - Fax:
Practice Address - Street 1:1560 W BAY AREA BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2667
Practice Address - Country:US
Practice Address - Phone:281-990-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01670363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant