Healthcare Provider Details

I. General information

NPI: 1336167766
Provider Name (Legal Business Name): DAVID BRUCE HASLAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE INFECTIOUS DISEASES - ML 7017
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE INFECTIOUS DISEASES - ML 7017
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4578
  • Fax: 513-636-7039
Mailing address:
  • Phone: 513-636-4578
  • Fax: 513-636-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number35.121886
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.121886
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: