Provider Demographics
NPI:1326443417
Name:HAYCOCK, RICHARD ADAM (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ADAM
Last Name:HAYCOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2207
Mailing Address - Country:US
Mailing Address - Phone:888-285-2269
Mailing Address - Fax:512-838-4264
Practice Address - Street 1:400 9TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-7398
Practice Address - Country:US
Practice Address - Phone:458-205-6555
Practice Address - Fax:458-205-6577
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170315782084P0800X
WI49-3212084P0800X
PAOS0196772084P0800X
ORDO1905172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry