Provider Demographics
NPI:1134351802
Name:BRIAN D. HAAS M.D. P.L.
Entity type:Organization
Organization Name:BRIAN D. HAAS M.D. P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-841-1490
Mailing Address - Street 1:415 BRIERCLIFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2203
Mailing Address - Country:US
Mailing Address - Phone:407-841-1490
Mailing Address - Fax:407-841-6464
Practice Address - Street 1:415 BRIERCLIFF DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2203
Practice Address - Country:US
Practice Address - Phone:407-841-1490
Practice Address - Fax:407-841-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0069320207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27885YMedicare PIN
FLF 71634Medicare UPIN