Provider Demographics
NPI:1801939129
Name:HAYNES, DEBORAH SUE (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 114TH AVE SE
Mailing Address - Street 2:#316
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-451-3997
Mailing Address - Fax:425-462-2966
Practice Address - Street 1:1309 114TH AVE SE
Practice Address - Street 2:316
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6903
Practice Address - Country:US
Practice Address - Phone:425-451-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000230102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1046374Medicaid
WA1046374Medicaid
WA109144Medicare ID - Type Unspecified