MEDICARE: DR. MARK HAAS D.P.M.

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	213E00000X	Podiatrist	136	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	16483	OTHER	NM	PRESBYTERIAN PIN
3	NM005346	OTHER	NM	BLUE CROSS PIN

General Provider Information

NPI Number	:	1790782837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK HAAS D.P.M.

Provider Business Mailing Address
First Line	:	8080 ACADEMY RD NE STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1159
Country	:	US
Telephone Number	:	505-247-4164
Fax Number	:

Provider Business Practice Location Address
First Line	:	8080 ACADEMY RD NE STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1159
Country	:	US
Telephone Number	:	505-247-4164
Fax Number	:

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	03/08/2010

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Directions to “ DR. MARK HAAS D.P.M.” Practice Location

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