Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 02001435 | IN |
NPI | 1144227596 |
---|---|
Provider Name | Dr. Irving I. Haber |
First Address | Terre Haute, IN 47804-4041 |
Second Address | Terre Haute, IN 47804-4041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000089341 | BC/BS PROVIDER NUMBER (01) | IN |
0638910001 | MEDICARE NSC (01) | IN |
200350460A | (05) | IN |
F59458 | (02) | IN |