Healthcare Provider Details

I. General information

NPI: 1770587701
Provider Name (Legal Business Name): THEODORE VINCENT HAAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 PENNSYLVANIA AVE STE 204
OTTUMWA IA
52501-6414
US

IV. Provider business mailing address

1005 PENNSYLVANIA AVE STE 204
OTTUMWA IA
52501-6414
US

V. Phone/Fax

Practice location:
  • Phone: 641-682-8761
  • Fax: 641-682-2764
Mailing address:
  • Phone: 641-682-8761
  • Fax: 641-682-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20687
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: