Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | TXG3423 | TX |
NPI | 1174533889 |
---|---|
Provider Name | Dr. Richard F. Haenke |
First Address | Bedford, TX 76021-1844 |
Second Address | Bedford, TX 76021-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B23243 | (02) | TX |