Provider Demographics
NPI:1578585139
Name:HAVERLY, DAVID E (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:HAVERLY
Suffix:
Gender:M
Credentials:DPM
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 914
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-0914
Mailing Address - Country:US
Mailing Address - Phone:931-787-1170
Mailing Address - Fax:931-210-5745
Practice Address - Street 1:49 CLEVELAND ST STE 320
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2854
Practice Address - Country:US
Practice Address - Phone:931-787-1170
Practice Address - Fax:931-210-5745
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM379213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351747Medicaid
TN3351747Medicaid
T92438Medicare UPIN
TN3353763Medicare PIN