Provider Demographics
NPI:1659524643
Name:HAAG, ERIC C (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:HAAG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 RIO ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5323
Mailing Address - Country:US
Mailing Address - Phone:505-787-9035
Mailing Address - Fax:
Practice Address - Street 1:4707 RIO ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-5323
Practice Address - Country:US
Practice Address - Phone:505-787-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPOD332213EP1101X, 213ES0131X
NM332213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2Q1443OtherINDIVIDUAL MEDICARE PTAN
NM74122355Medicaid
NM6N8581OtherGROUP MEDICARE PTAN