Doctor Name: | DR. DOUGLAS JOHN HABERMAN |
NPI Number: | 1033128012 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | R3G75 |
Business Practice Address: | 126 Missouri Ave Mcxp-ccs-cr Fort Leonard Wood, MO - 654738952 |
Business Phone Number: | 5735960417 |
Business Fax Number: | 5735960524 |
Mailing Address: | 126 Missouri Ave, Mcxp-ccs-cr FORT LEONARD WOOD |
State: | MO |
Postal Code: | 654738952 |
Phone Number: | 5735960417 |
Fax Number: | 5735960524 |
NPI Enumeration Date: | 08/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | R3G75 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |