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NPI Code Detail

MEDICARE: DR. MICHAEL S HAVERTY MD

MEDICARE: DR. MICHAEL S HAVERTY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianG53646CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G53646OTHERCABLUE CROSS
200G536460OTHERCABLUE SHIELD PIN

General Provider Information

NPI Number : 1235114729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL S HAVERTY MD
Provider Business Mailing Address
First Line : 2342 PROFESSIONAL PKWY
Second Line : SUITE 260
City : SANTA MARIA
State : CA
Zip : 93455-1629
Country : US
Telephone Number : 805-348-3910
Fax Number : 805-348-3901
Provider Business Practice Location Address
First Line : 2342 PROFESSIONAL PKWY
Second Line : SUITE 260
City : SANTA MARIA
State : CA
Zip : 93455-1629
Country : US
Telephone Number : 805-348-3910
Fax Number : 805-348-3901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 03/04/2014

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