Provider Demographics
NPI:1629014493
Name:HAAS, JAMIE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:T
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 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:639-390-1776
Mailing Address - Fax:636-390-1775
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:639-390-1776
Practice Address - Fax:636-390-1775
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040361832084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209402700Medicaid
MOP01221222OtherRAILROAD MEDICARE
MO1629014493Medicaid
P00445877OtherRAILROAD MEDICARE
I10714Medicare UPIN
MO1629014493Medicaid
MO209402700Medicaid