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NPI Code Detail

MEDICARE: DARIN R HAIVALA M.D.

MEDICARE: DARIN R HAIVALA 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
1207W00000XOphthalmology Physician21377OK
2207WX0107XRetina Specialist (Ophthalmology) Physician21377OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689641342
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARIN R HAIVALA M.D.
Provider Business Mailing Address
First Line : 12318 SAINT ANDREWS DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-8604
Country : US
Telephone Number : 405-752-0717
Fax Number :
Provider Business Practice Location Address
First Line : 12318 SAINT ANDREWS DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-8604
Country : US
Telephone Number : 405-752-0717
Fax Number : 405-752-0711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2006
Last Update Date : 04/21/2017

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Directions to “ DARIN R HAIVALA M.D.” Practice Location

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