Provider Demographics
NPI:1235172610
Name:HAVENER, STEVEN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:HAVENER
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 1:1406 MOCKINGBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4707
Mailing Address - Country:US
Mailing Address - Phone:956-972-0032
Mailing Address - Fax:
Practice Address - Street 1:1920 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3106
Practice Address - Country:US
Practice Address - Phone:956-584-3353
Practice Address - Fax:956-584-3253
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1682705OtherUNITED HEALTHCARE
TX5306200OtherCIGNA
TX89W301OtherBLUE CROSS/SHIELD
TX118914OtherSUPERIOR HEALTH NETWORK
TX89W301Medicare ID - Type Unspecified
TXA02821Medicare UPIN