Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | L0234 | TX |
N | 207KA0200X | Allergist | L0234 | TX |
N | 207R00000X | Internist | L0234 | TX |
N | 111NI0900X | Internist | L0234 | TX |
Y | 207RA0201X | Internist - Allergy & Immunology | L0234 | TX |
NPI | 1588691125 |
---|---|
Provider Name | Dr. James Russell Haden |
First Address | Fort Worth, TX 76104-3033 |
Second Address | Fort Worth, TX 76104-3033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H29144 | (02) | TX |