Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 92313 | CA |
Y | 207RX0202X | Medical Oncology | 92313 | CA |
NPI | 1225002694 |
---|---|
Provider Name | Robert Allan Havard JR. |
First Address | Visalia, CA 93277 |
Second Address | Visalia, CA 93277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 29/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52792 | (02) | |
AH2112162 | DEA (01) | CA |