Provider Demographics
NPI:1417151093
Name:HAVEMANN, DARA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:LYNN
Last Name:HAVEMANN
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 1:2840 LEGACY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6049
Mailing Address - Country:US
Mailing Address - Phone:214-297-0027
Mailing Address - Fax:
Practice Address - Street 1:2840 LEGACY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6049
Practice Address - Country:US
Practice Address - Phone:221-429-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3183207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2766284677OtherMYUTMB 2766284677-COMMERCIAL NUMBER