Provider Demographics
NPI:1205865813
Name:HAIBACH, PETER JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:HAIBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FURMAN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5038
Mailing Address - Country:US
Mailing Address - Phone:828-262-0060
Mailing Address - Fax:828-262-0062
Practice Address - Street 1:136 FURMAN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5038
Practice Address - Country:US
Practice Address - Phone:828-262-0060
Practice Address - Fax:828-262-0062
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27800207R00000X
TNMD0000013321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4176480Medicaid
NC38193OtherBCBS NC
NC8938193Medicaid
TN98499OtherBCBS TN
NCB04190Medicare UPIN
TN98499OtherBCBS TN