Healthcare Provider Details

I. General information

NPI: 1740368695
Provider Name (Legal Business Name): JOSEPH JEFFREY HABERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 NE 102ND AVE
PORTLAND OR
97220
US

IV. Provider business mailing address

6430 NW SISTERS PL
CORVALLIS OR
97330-9243
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-1105
  • Fax: 503-535-8398
Mailing address:
  • Phone: 541-745-5555
  • Fax: 541-745-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD16023
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0044345
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: