Provider Demographics
NPI:1952367260
Name:HAYNES, RUSSELL MEYER (LAT, EMT-B)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:MEYER
Last Name:HAYNES
Suffix:
Gender:M
Credentials:LAT, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 EL PASO DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-8654
Mailing Address - Country:US
Mailing Address - Phone:319-337-6031
Mailing Address - Fax:
Practice Address - Street 1:40 RECREATION BUILDING
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1186
Practice Address - Country:US
Practice Address - Phone:319-335-9538
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-08-241-27146N00000X
IA001162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer