Provider Demographics
NPI:1265458111
Name:HAYNES, PHILIP (MD PHD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MD PHD
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 2291
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77549-2291
Mailing Address - Country:US
Mailing Address - Phone:832-694-5586
Mailing Address - Fax:
Practice Address - Street 1:7215 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4601
Practice Address - Country:US
Practice Address - Phone:281-487-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066961207P00000X
RIMD09556207P00000X
TXK8206207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105449606Medicaid
TX105449606Medicaid