Provider Demographics
NPI:1972954220
Name:HAYNES, ERIC CHARLES (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:CHARLES
Last Name:HAYNES
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 1:905 E COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1262
Mailing Address - Country:US
Mailing Address - Phone:231-672-8050
Mailing Address - Fax:231-672-8048
Practice Address - Street 1:905 E COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1262
Practice Address - Country:US
Practice Address - Phone:231-672-8050
Practice Address - Fax:231-672-8048
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025044207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine