Provider Demographics
NPI:1720194749
Name:PAULJOHN HAYNER MD PC
Entity Type:Organization
Organization Name:PAULJOHN HAYNER MD PC
Other - Org Name:RENAISSANCE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULJOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-338-4325
Mailing Address - Street 1:PO BOX 23200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3200
Mailing Address - Country:US
Mailing Address - Phone:503-968-2779
Mailing Address - Fax:
Practice Address - Street 1:1230 MARINE DR
Practice Address - Street 2:201
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4059
Practice Address - Country:US
Practice Address - Phone:503-338-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF3546OtherRAILROAD MEDICARE GROUP
ORP00358641OtherRAILROAD MEDICARE
ORR135900Medicare PIN