Provider Demographics
NPI:1831471093
Name:HABIB, HABIB (MD)
Entity type:Individual
Prefix:
First Name:HABIB
Middle Name:
Last Name:HABIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 E MARCH LN STE D400
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6675
Mailing Address - Country:US
Mailing Address - Phone:209-464-3615
Mailing Address - Fax:209-464-1537
Practice Address - Street 1:1801 E MARCH LN STE D400
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6675
Practice Address - Country:US
Practice Address - Phone:209-464-3615
Practice Address - Fax:209-464-1537
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD460501207RC0000X
CAA154787207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease