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General NPI Number Information
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NPI Number | 1922143767
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Entity Type | Organization
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Legal Business Name | M JOSHUA HABER MD LLC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 62968 O B RILEY RD BUILDING A-1
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City | BEND
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State | OR
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Zip | 97701-9442
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Country | US
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Telephone | 541-389-4848
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6673
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City | BEND
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State | OR
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Zip | 97708-6673
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Country | US
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Telephone | 541-389-4848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JOSHUA HABER
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Credential | MD
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Telephone | 541-389-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 18811
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License Number State | OR
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