=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205264918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS FRANK HAAS MD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2013
-----------------------------------------------------
Last Update Date | 10/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 SE SAINT LUCIE BLVD APT 203
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34996-4769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-781-7369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 SE SAINT LUCIE BLVD 203
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34996-4769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-341-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 15968
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------