Provider Demographics
NPI:1588610083
Name:HAAS, STEPHAN O (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:O
Last Name:HAAS
Suffix:
Gender:M
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:PO BOX 678207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8207
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:706-653-1162
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6522
Practice Address - Fax:888-972-8644
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ64742085N0700X, 2085R0202X
SC818962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200001490AMedicaid
TX030644103Medicaid
114261103OtherFIRSTCARE
NM25754289Medicaid
MDJ6474OtherWORKERS COMPENSATION
TX8F7708OtherTEXAS BCBS
TX030644103Medicaid
MDJ6474OtherWORKERS COMPENSATION
TX8F7905Medicare PIN