Provider Demographics
NPI:1679746622
Name:HASELOW, DIRK THOMAS (MD, PHD, MS)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:THOMAS
Last Name:HASELOW
Suffix:
Gender:M
Credentials:MD, PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9408 MILLERS POINTE CT
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2491
Mailing Address - Country:US
Mailing Address - Phone:501-442-8149
Mailing Address - Fax:
Practice Address - Street 1:9408 MILLERS POINTE CT
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2491
Practice Address - Country:US
Practice Address - Phone:501-442-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics