Basic Information
| Provider Information | |||||||||
| NPI: | 1396765152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAINES | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1035 | ||||||||
| Address2: | |||||||||
| City: | CORRALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870481035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058991441 | ||||||||
| FaxNumber: | 5058960580 | ||||||||
| Practice Location | |||||||||
| Address1: | 1424 DEBORAH RD SE | ||||||||
| Address2: | SUITE # 101 | ||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871241058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058960928 | ||||||||
| FaxNumber: | 5058960585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 93-69 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.