Provider Demographics
NPI:1275646119
Name:HAITAS, BYRON (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:HAITAS
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 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-342-5975
Mailing Address - Fax:615-342-5919
Practice Address - Street 1:2400 PATTERSON STREETT
Practice Address - Street 2:SUITE 304
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-342-5975
Practice Address - Fax:615-342-5919
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD018628207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716315Medicaid
A99562Medicare UPIN
3631956Medicare ID - Type Unspecified