Provider Demographics
NPI:1194836551
Name:HAEN, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:HAEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:#540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5209
Mailing Address - Country:US
Mailing Address - Phone:417-269-6262
Mailing Address - Fax:417-269-4349
Practice Address - Street 1:1443 N ROBBERSON AVE
Practice Address - Street 2:#1001
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-1928
Practice Address - Country:US
Practice Address - Phone:417-269-3858
Practice Address - Fax:417-269-3821
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO31463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A11819Medicare UPIN