=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518924471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID CHARLES HAAS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 02/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 CLUB MANOR DR SUITE J
-----------------------------------------------------
City | MAUMELLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72113-7411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-687-0488
-----------------------------------------------------
Fax | 501-687-0489
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 CLUB MANOR DR SUITE J
-----------------------------------------------------
City | MAUMELLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72113-7411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-687-0488
-----------------------------------------------------
Fax | 501-687-0489
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | E-0446
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | E-0446
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------