Provider Demographics
NPI:1528207024
Name:STEVEN P HAVARD, MD, PA
Entity Type:Organization
Organization Name:STEVEN P HAVARD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:ATHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-225-2718
Mailing Address - Street 1:1759 BROAD PARK CIR S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7833
Mailing Address - Country:US
Mailing Address - Phone:817-225-2718
Mailing Address - Fax:817-225-2771
Practice Address - Street 1:1759 BROAD PARK CIR S
Practice Address - Street 2:SUITE 201
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7833
Practice Address - Country:US
Practice Address - Phone:817-225-2718
Practice Address - Fax:817-225-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9235207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168236101Medicaid
TX168236101Medicaid
TX8C2578Medicare PIN