Provider Demographics
NPI:1922143767
Name:M JOSHUA HABER MD LLC
Entity Type:Organization
Organization Name:M JOSHUA HABER MD LLC
Other - Org Name:NON-SURGICAL SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-389-4848
Mailing Address - Street 1:PO BOX 6673
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6673
Mailing Address - Country:US
Mailing Address - Phone:541-389-4848
Mailing Address - Fax:
Practice Address - Street 1:62968 O B RILEY RD
Practice Address - Street 2:BUILDING A-1
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9442
Practice Address - Country:US
Practice Address - Phone:541-389-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18811207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113240Medicare ID - Type UnspecifiedINDIVIDUAL ID #
ORR113241Medicare ID - Type UnspecifiedGROUP ID #