Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34749 | CO |
NPI | 1639131220 |
---|---|
Provider Name | Dr. Brent Alan Haskell |
First Address | Canon City, CO 81212-2302 |
Second Address | Canon City, CO 81212-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 07/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13329 | CO ANTHEM PIN (01) | CO |
89F14HA | BCBS OF MINN. PIN (01) | CO |
A01226 | (02) | CO |
P00027804 | RAILROAD MEDICARE PIN (01) | CO |