Healthcare Provider Details

I. General information

NPI: 1518016161
Provider Name (Legal Business Name): GERALD M HAASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSP OF DENVER 1056 E. 19TH AVE., BOX B-190
DENVER CO
80218
US

IV. Provider business mailing address

5655 S GRAPE CT
GREENWOOD VILLAGE CO
80121-2116
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-6278
  • Fax:
Mailing address:
  • Phone: 303-861-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number37569
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: