Doctor Name: | LYLE F HABERLAND |
NPI Number: | 1134118300 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 1848A |
Business Practice Address: | 808 E 5th St Powell, WY - 824352106 |
Business Phone Number: | 3077544262 |
Business Fax Number: | 3077549303 |
Mailing Address: | 808 E 5th St, POWELL |
State: | WY |
Postal Code: | 824352106 |
Phone Number: | 3077544262 |
Fax Number: | 3077549303 |
NPI Enumeration Date: | 10/19/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 1848A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |