1467439653 NPI number — BRADLEY N HAAS MD

Table of content: BRADLEY N HAAS MD (NPI 1467439653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467439653 NPI number — BRADLEY N HAAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAAS
Provider First Name:
BRADLEY
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467439653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4567 MERGANSER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34119-7970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-480-5710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4567 MERGANSER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34119-7970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-480-5710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  35956 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: ME158988 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113572400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100312690A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84113438513 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01359561 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3506685 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: T4723 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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