Provider Demographics
NPI:1659368496
Name:HAAS, ROBERT WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILSON
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:WILSON
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-6066
Mailing Address - Fax:816-792-5130
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-6066
Practice Address - Fax:816-792-5130
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34585207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396761334OtherLIBERTY ORTHOPEDIC ASSOCIATES, PC NPI
MO0388010001OtherDMERC
MO4750000OtherLIBERTY ORTHOPEDIC ASSOCIATES, PC PTAN
MO4753996OtherMEDICARE PTAN
MO200832301Medicaid
MO4753996OtherMEDICARE PTAN