Provider Demographics
NPI:1881905917
Name:HAVENS, TIMOTHY R (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:HAVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3635 VISTA AVE
Mailing Address - Street 2:ST LOUIS UNIVERSITY HOSPITAL, WEST PAVILLION, RM 320
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2539
Mailing Address - Country:US
Mailing Address - Phone:314-577-8780
Mailing Address - Fax:314-268-5697
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:ST LOUIS UNIVERSITY HOSPITAL, WEST PAVILLION, RM 320
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-577-8780
Practice Address - Fax:314-268-5697
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2010017732207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine