Healthcare Provider Details

I. General information

NPI: 1649981408
Provider Name (Legal Business Name): MJ HABER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 OAK ST
EUGENE OR
97401-4022
US

IV. Provider business mailing address

1056 GREEN ACRES RD STE 102-341
EUGENE OR
97408-1505
US

V. Phone/Fax

Practice location:
  • Phone: 541-800-8970
  • Fax: 541-654-4282
Mailing address:
  • Phone: 541-800-8970
  • Fax: 541-844-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: M JOSHUA HABER
Title or Position: OWNER
Credential: MD
Phone: 541-800-8970