Healthcare Provider Details

I. General information

NPI: 1790718682
Provider Name (Legal Business Name): PHILLIP J HABERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 WRIGHT DR
LOVELAND CO
80538-8806
US

IV. Provider business mailing address

5802 WRIGHT DR
LOVELAND CO
80538-8806
US

V. Phone/Fax

Practice location:
  • Phone: 970-212-0530
  • Fax:
Mailing address:
  • Phone: 970-212-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberDR.0054737
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number6366A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number17949
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDR.0054737
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: