Provider Demographics
NPI:1770977688
Name:HAVERMAN, DAVID SAMUEL (MD MPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:HAVERMAN
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 NW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1414
Mailing Address - Country:US
Mailing Address - Phone:561-715-2914
Mailing Address - Fax:
Practice Address - Street 1:1029 NW 18TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1414
Practice Address - Country:US
Practice Address - Phone:561-715-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139215207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology