Provider Demographics
NPI:1558357186
Name:HAAS, GERALD L (DO)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:HAAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-0127
Mailing Address - Country:US
Mailing Address - Phone:641-932-7172
Mailing Address - Fax:641-932-7174
Practice Address - Street 1:6582 165TH ST
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-8793
Practice Address - Country:US
Practice Address - Phone:641-932-7172
Practice Address - Fax:641-932-7174
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0192021Medicaid
IA19202OtherWELLMARK,, BCBS
IA19201Medicare ID - Type Unspecified
IA0192021Medicaid