MEDICARE: MARY CLAIRE HAVER 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
1	174400000X	Specialist	L3992	TX
2	207V00000X	Obstetrics & Gynecology Physician	L3992	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8G8200	OTHER	TX	BC/BS NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285634477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CLAIRE HAVER M.D.

Provider Business Mailing Address
First Line	:	1705 BAYOU SHORE DR
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-4334
Country	:	US
Telephone Number	:	409-370-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 BAYOU SHORE DR
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551
Country	:	US
Telephone Number	:	407-370-2227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/09/2018

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