Healthcare Provider Details

I. General information

NPI: 1871806950
Provider Name (Legal Business Name): ABIGAIL LEE HABERMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 NW CALLOWAY DR
CORVALLIS OR
97330-9598
US

IV. Provider business mailing address

690 NW CALLOWAY DR
CORVALLIS OR
97330-9598
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-2757
  • Fax:
Mailing address:
  • Phone: 541-754-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIGAIL HABERMAN
Title or Position: M.D.
Credential: M.D.
Phone: 541-754-2757