1518213263 NPI number — SEAN GREGORY HASLAM M.D., FRCSC, FAAOS

Table of content: SEAN GREGORY HASLAM M.D., FRCSC, FAAOS (NPI 1518213263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518213263 NPI number — SEAN GREGORY HASLAM M.D., FRCSC, FAAOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASLAM
Provider First Name:
SEAN
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., FRCSC, FAAOS
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:
1518213263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 COIT ROAD
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-800-7070
Provider Business Mailing Address Fax Number:
469-800-7080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 COIT ROAD
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-287-7179
Provider Business Practice Location Address Fax Number:
972-596-9382
Provider Enumeration Date:
07/31/2012

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: 207X00000X , with the licence number:  P0903 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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