Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 23739 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | N4460 | TX |
NPI | 1568672996 |
---|---|
Provider Name | Dr. Mark E Haverkorn |
First Address | San Antonio, TX 78249-5463 |
Second Address | San Antonio, TX 78249-5463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 11/10/2018 |