Provider Demographics
NPI:1497865448
Name:HAVERLAH, VERNON C (DO)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:C
Last Name:HAVERLAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4360 GRECO DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-2725
Mailing Address - Country:US
Mailing Address - Phone:210-648-8200
Mailing Address - Fax:210-648-8204
Practice Address - Street 1:220 W GOODWIN ST
Practice Address - Street 2:STE. A
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4115
Practice Address - Country:US
Practice Address - Phone:830-569-2118
Practice Address - Fax:830-281-5958
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF4058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-2972962OtherTAX ID