Provider Demographics
NPI:1770761066
Name:DAVID W HABER DO PA
Entity type:Organization
Organization Name:DAVID W HABER DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-488-0074
Mailing Address - Street 1:417 COMMERCIAL CT STE A6
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1655
Mailing Address - Country:US
Mailing Address - Phone:941-488-0074
Mailing Address - Fax:941-488-2074
Practice Address - Street 1:417 COMMERCIAL CT STE A6
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1655
Practice Address - Country:US
Practice Address - Phone:941-488-0074
Practice Address - Fax:941-488-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007288207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0080Medicare PIN