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NPI Code Detail

MEDICARE: MICHAEL S HAVERTY MD INC

MEDICARE: MICHAEL S HAVERTY MD INC
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
1207Q00000XFamily Medicine PhysicianG53646CA

General Provider Information

NPI Number : 1952445595
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL S HAVERTY MD INC
Provider Business Mailing Address
First Line : 2342 PROFESSIONAL PKWY
Second Line : SUITE 260
City : SANTA MARIA
State : CA
Zip : 93455-1629
Country : US
Telephone Number : 805-348-3950
Fax Number : 805-348-9301
Provider Business Practice Location Address
First Line : 2342 PROFESSIONAL PKWY
Second Line : SUITE 260
City : SANTA MARIA
State : CA
Zip : 93455-1629
Country : US
Telephone Number : 805-348-3950
Fax Number : 805-348-9301
Authorized Official
Title or Position : OWNER
Name : MICHAEL S HAVERTY
Credential : MD
Telephone Number : 805-348-3910
Provider Enumeration Date : 02/16/2007
Last Update Date : 03/04/2014

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