Provider Demographics
NPI:1942405121
Name:HAAS, JEFF M (LMP)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:M
Last Name:HAAS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25808 188TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6043
Mailing Address - Country:US
Mailing Address - Phone:253-630-4196
Mailing Address - Fax:253-813-2673
Practice Address - Street 1:10830 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-9959
Practice Address - Country:US
Practice Address - Phone:253-813-2672
Practice Address - Fax:253-813-2673
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023589175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath