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NPI Code Detail

MEDICARE: JOANN D HABERMAN M.D.

MEDICARE: JOANN D HABERMAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician9202OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11043467723OTHEROKCORP NPI

General Provider Information

NPI Number : 1235286923
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANN D HABERMAN M.D.
Provider Business Mailing Address
First Line : 6307 WATERFORD BLVD
Second Line : SUITE 100
City : OKLAHOMA CITY
State : OK
Zip : 73118-1117
Country : US
Telephone Number : 405-607-6359
Fax Number : 405-607-8256
Provider Business Practice Location Address
First Line : 6307 WATERFORD BLVD
Second Line : SUITE 100
City : OKLAHOMA CITY
State : OK
Zip : 73118-1117
Country : US
Telephone Number : 405-607-6359
Fax Number : 405-607-8256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 05/29/2014

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