Provider Demographics
NPI:1740318112
Name:HAAS, ELSON M (MD)
Entity type:Individual
Prefix:DR
First Name:ELSON
Middle Name:M
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25 MITCHELL BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2007
Mailing Address - Country:US
Mailing Address - Phone:415-472-2343
Mailing Address - Fax:415-472-7636
Practice Address - Street 1:25 MITCHELL BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2007
Practice Address - Country:US
Practice Address - Phone:415-472-2343
Practice Address - Fax:415-472-7636
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG251970207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG251970OtherLICENSE
CAA42567Medicare UPIN
CA00G251970Medicare ID - Type Unspecified