Healthcare Provider Details

I. General information

NPI: 1457330771
Provider Name (Legal Business Name): DAVID H HAASE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556B FIRE STATION RD
CLARKSVILLE TN
37043-4016
US

IV. Provider business mailing address

556B FIRE STATION RD
CLARKSVILLE TN
37043-4016
US

V. Phone/Fax

Practice location:
  • Phone: 931-648-9595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000036755
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: