Provider Demographics
NPI:1902852320
Name:HAAR, KEITH J (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:HAAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7300 RANCH ROAD 2222, BUILDING 1, STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730
Mailing Address - Country:US
Mailing Address - Phone:512-628-0465
Mailing Address - Fax:
Practice Address - Street 1:7767 W. DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2103
Practice Address - Country:US
Practice Address - Phone:623-487-3003
Practice Address - Fax:623-487-0952
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25303207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ63142OtherMEDICARE PTAN
AZG61193Medicare UPIN