Provider Demographics
NPI:1235286923
Name:HABERMAN, JOANN D (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:D
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 WATERFORD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1117
Mailing Address - Country:US
Mailing Address - Phone:405-607-6359
Mailing Address - Fax:405-607-8256
Practice Address - Street 1:6307 WATERFORD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1117
Practice Address - Country:US
Practice Address - Phone:405-607-6359
Practice Address - Fax:405-607-8256
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1043467723OtherCORP NPI
OKD34740Medicare UPIN
OKOK700515Medicare PIN
OK$$$$$$$$$Medicare PIN