Healthcare Provider Details

I. General information

NPI: 1427036961
Provider Name (Legal Business Name): ROBERT LEE HAISLER LMSW-ACP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC-KITZINGEN-SOCIAL WORK UNIT 26137
APO AE
09031
US

IV. Provider business mailing address

CMR 448, BOX 739
APO AE
09225
US

V. Phone/Fax

Practice location:
  • Phone: 93213058906
  • Fax: 93213058544
Mailing address:
  • Phone: 93213058906
  • Fax: 93213058544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberSO2454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: