Provider Demographics
NPI:1285634477
Name:HAVER, MARY CLAIRE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CLAIRE
Last Name:HAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CLAIRE
Other - Last Name:PASTOR HAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1705 BAYOU SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-4334
Mailing Address - Country:US
Mailing Address - Phone:409-370-2227
Mailing Address - Fax:
Practice Address - Street 1:1705 BAYOU SHORE DR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551
Practice Address - Country:US
Practice Address - Phone:407-370-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3992174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G8200OtherBC/BS NUMBER
TX1546541-01Medicaid
TX8G8200OtherBC/BS NUMBER