Provider Demographics
NPI:1356304687
Name:HAGGSTROM, GERARD DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:DONALD
Last Name:HAGGSTROM
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 1:416 N. SEMINARY STREET
Mailing Address - Street 2:STE 3100
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-766-8667
Mailing Address - Fax:256-767-5327
Practice Address - Street 1:416 N. SEMINARY STREET
Practice Address - Street 2:STE 3100
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-766-8667
Practice Address - Fax:256-767-5327
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006975207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100016505OtherPALMETTO GBA
TN4042119OtherBLUE CROSS BLUE SHIELD TN
AL009996990Medicaid
AL100016505OtherPALMETTO GBA