Provider Demographics
NPI:1477667053
Name:HABER, M JOSHUA (MD)
Entity type:Individual
Prefix:
First Name:M
Middle Name:JOSHUA
Last Name:HABER
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 1:1056 GREEN ACRES RD STE 102-341
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1505
Mailing Address - Country:US
Mailing Address - Phone:541-800-8970
Mailing Address - Fax:541-685-4282
Practice Address - Street 1:1605 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4022
Practice Address - Country:US
Practice Address - Phone:541-800-8970
Practice Address - Fax:541-844-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18811207QS0010X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
140118Medicare UPIN