Provider Demographics
NPI:1134111263
Name:HAECKLER, CHRISTOPHER R (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:HAECKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E LOOP 304
Mailing Address - Street 2:STE 200
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1814
Mailing Address - Country:US
Mailing Address - Phone:936-544-5132
Mailing Address - Fax:936-544-5572
Practice Address - Street 1:1050 E LOOP 304
Practice Address - Street 2:STE 200
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1814
Practice Address - Country:US
Practice Address - Phone:936-544-5132
Practice Address - Fax:936-544-5572
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136289902Medicaid
TX00NN64Medicare PIN
TX136289902Medicaid