Provider Demographics
NPI:1750312328
Name:HASTE, JEFFREY L (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:HASTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0928
Mailing Address - Country:US
Mailing Address - Phone:417-659-9395
Mailing Address - Fax:417-659-9695
Practice Address - Street 1:1617 W 26TH ST STE A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0322
Practice Address - Country:US
Practice Address - Phone:417-659-9395
Practice Address - Fax:417-659-9695
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00085085OtherRR MEDICARE
MO157819OtherBCBS
MO303890222Medicaid
MO544172001OtherMEDICARE NORIDIAN DME
MO157819OtherBCBS
MO256205003Medicare PIN
MOP00085085OtherRR MEDICARE
MO303890222Medicaid