Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | M6181 | ID |
Y | 207Q00000X | Family Doctor | M6181 | ID |
NPI | 1073535506 |
---|---|
Provider Name | Dr. Jeffrey C Haskell X |
First Address | Idaho Falls, ID 83404-8321 |
Second Address | Idaho Falls, ID 83404-8321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003739200 | (05) | ID |
F36927 | (02) | ID |