MEDICARE: DR. BRIAN JAMES HASELOFF 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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	L9727	TX
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	L9727	TX

General Provider Information

NPI Number	:	1942314356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JAMES HASELOFF MD

Provider Business Mailing Address
First Line	:	3501 S SONCY RD STE 1002
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79119-4932
Country	:	US
Telephone Number	:	806-341-2188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 S SONCY RD STE 1002
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79119-4932
Country	:	US
Telephone Number	:	806-341-2188
Fax Number	:	806-731-4300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/21/2022

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