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NPI Code Detail

MEDICARE: DR. BRENT ALAN HASKELL D.O.

MEDICARE: DR. BRENT ALAN HASKELL D.O.
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
1204D00000XNeuromusculoskeletal Medicine & OMM Physician34749CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00027804OTHERCORAILROAD MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113329OTHERCOCO ANTHEM PIN
289F14HAOTHERCOBCBS OF MINN. PIN

General Provider Information

NPI Number : 1639131220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENT ALAN HASKELL D.O.
Provider Business Mailing Address
First Line : 1338 PHAY AVE
Second Line :
City : CANON CITY
State : CO
Zip : 81212-2302
Country : US
Telephone Number : 719-285-2646
Fax Number : 719-285-2647
Provider Business Practice Location Address
First Line : 1338 PHAY AVE
Second Line :
City : CANON CITY
State : CO
Zip : 81212-2302
Country : US
Telephone Number : 719-285-2646
Fax Number : 719-285-2647
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 12/07/2012

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