Provider Demographics
NPI:1790782837
Name:HAAS, MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:HAAS
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 1:8080 ACADEMY RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1159
Mailing Address - Country:US
Mailing Address - Phone:505-247-4164
Mailing Address - Fax:
Practice Address - Street 1:8080 ACADEMY RD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1159
Practice Address - Country:US
Practice Address - Phone:505-247-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54304Medicaid
NM16483OtherPRESBYTERIAN PIN
NMNM005346OtherBLUE CROSS PIN
6203220001Medicare NSC
NMNM005346OtherBLUE CROSS PIN
NMT41082Medicare UPIN