Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | R9072 | MO |
Y | 207Q00000X | Family Doctor | R9072 | MO |
NPI | 1043234735 |
---|---|
Provider Name | Dr. Jerry L Haman |
First Address | Kirksville, MO 63501-0661 |
Second Address | Kirksville, MO 63501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 04/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C51192 | (02) | MO |