Provider Demographics
NPI:1841383197
Name:HAAG, TERRY A (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
Last Name:HAAG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2028
Mailing Address - Country:US
Mailing Address - Phone:321-841-5281
Mailing Address - Fax:407-648-9879
Practice Address - Street 1:83 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2028
Practice Address - Country:US
Practice Address - Phone:321-841-5281
Practice Address - Fax:407-648-9879
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10169207V00000X
UT9185491-1204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113969Medicaid
FL280166300Medicaid
FL09806OtherBCBS OF FLORIDA
FLOS10169OtherMEDICAL LICENSE
IL036113969Medicaid
FL280166300Medicaid
ILK19577Medicare ID - Type UnspecifiedINDIVIDUAL #
IL036113969Medicaid