Provider Demographics
NPI:1720560857
Name:HAUBERT, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HAUBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 ROANOKE ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2748
Mailing Address - Country:US
Mailing Address - Phone:330-418-7557
Mailing Address - Fax:330-775-7677
Practice Address - Street 1:2828 ROANOKE ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2748
Practice Address - Country:US
Practice Address - Phone:330-418-7557
Practice Address - Fax:330-775-7677
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH765695172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver