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General NPI Number Information
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NPI Number | 1003989260
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Entity Type | Individual
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Provider Name | DIRK FRANCIS HAVLAK MD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5130 CORPORATE CENTER CT SE
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City | LACEY
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State | WA
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Zip | 98503-5957
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Country | US
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Telephone | 360-413-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 CAMDEN CIR SW
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City | OLYMPIA
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State | WA
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Zip | 98512-5552
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Country | US
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Telephone | 360-943-2734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00020629
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License Number State | WA
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