Provider Demographics
NPI:1154332096
Name:HAYNES, ROBERT E (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12333 NE 130TH LANE
Mailing Address - Street 2:#320
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3039
Mailing Address - Country:US
Mailing Address - Phone:425-899-0555
Mailing Address - Fax:425-899-1333
Practice Address - Street 1:12333 NE 130TH LANE
Practice Address - Street 2:#320
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3039
Practice Address - Country:US
Practice Address - Phone:425-899-0555
Practice Address - Fax:425-899-1333
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAWA15057207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1195908Medicaid
WA0102162Medicare ID - Type Unspecified
WA1195908Medicaid