Provider Demographics
NPI:1366755787
Name:ROBERT F. HAYNSWORTH JR., PA
Entity type:Organization
Organization Name:ROBERT F. HAYNSWORTH JR., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAYNSWORTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:469-814-5960
Mailing Address - Street 1:4708 ALLIANCE BLVD STE 810
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5338
Mailing Address - Country:US
Mailing Address - Phone:469-814-5960
Mailing Address - Fax:972-767-4847
Practice Address - Street 1:4708 ALLIANCE BLVD STE 810
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5338
Practice Address - Country:US
Practice Address - Phone:469-814-5960
Practice Address - Fax:469-814-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9544208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033600001Medicaid
B23363Medicare UPIN
TX033600001Medicaid
TXTXB104716Medicare PIN