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General NPI Number Information
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NPI Number | 1679746622
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Entity Type | Individual
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Provider Name | DIRK THOMAS HASELOW MD, PHD, MS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 9408 MILLERS POINTE CT
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City | SHERWOOD
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State | AR
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Zip | 72120-2491
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Country | US
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Telephone | 501-442-8149
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Fax |
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Provider Business Mailing Address
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Address Line | 9408 MILLERS POINTE CT
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City | SHERWOOD
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State | AR
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Zip | 72120-2491
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Country | US
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Telephone | 501-442-8149
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-6705
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License Number State | AR
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