Healthcare Provider Details

I. General information

NPI: 1942405121
Provider Name (Legal Business Name): JEFF M. HAAS L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 SE KENT KANGLEY RD
KENT WA
98030-9959
US

IV. Provider business mailing address

25808 188TH AVE SE
COVINGTON WA
98042-6043
US

V. Phone/Fax

Practice location:
  • Phone: 253-813-2672
  • Fax: 253-813-2673
Mailing address:
  • Phone: 253-630-4196
  • Fax: 253-813-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberMA00023589
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: