Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7394 | AZ |
N | 111NR0400X | Rehabilitation Chiropractor | 7394 | AZ |
NPI | 1144223561 |
---|---|
Provider Name | Dr. William M Haas |
First Address | Peoria, AZ 85381-4240 |
Second Address | Peoria, AZ 85381-4240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0939450 | BCBS ID (01) | AZ |
U97559 | (02) | |
Z103320 | MEDICARE ID-PIN (01) | AZ |