Provider Demographics
NPI:1538435334
Name:HAINES, JOE OLIVER I (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:OLIVER
Last Name:HAINES
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:OLIVER
Other - Last Name:HAINES
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:512 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-6708
Mailing Address - Country:US
Mailing Address - Phone:650-579-0632
Mailing Address - Fax:650-375-1708
Practice Address - Street 1:512 CRAIG RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:CA
Practice Address - Zip Code:94010-6708
Practice Address - Country:US
Practice Address - Phone:650-579-0632
Practice Address - Fax:650-375-1708
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE295922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology