Provider Demographics
NPI:1396765541
Name:HANEY, BYRON L (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:L
Last Name:HANEY
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 1:107 E MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-5312
Mailing Address - Country:US
Mailing Address - Phone:509-962-6348
Mailing Address - Fax:
Practice Address - Street 1:107 E MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-5312
Practice Address - Country:US
Practice Address - Phone:509-962-6348
Practice Address - Fax:509-962-2003
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1058312Medicaid
WA1058312Medicaid