Healthcare Provider Details

I. General information

NPI: 1558357186
Provider Name (Legal Business Name): GERALD L HAAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6582 165TH ST
ALBIA IA
52531-8793
US

IV. Provider business mailing address

PO BOX 127
ALBIA IA
52531-0127
US

V. Phone/Fax

Practice location:
  • Phone: 641-932-7172
  • Fax: 641-932-7174
Mailing address:
  • Phone: 641-932-7172
  • Fax: 641-932-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01862
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: