Provider Demographics
NPI:1982717567
Name:HAEBERLIN, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HAEBERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2756
Mailing Address - Country:US
Mailing Address - Phone:218-739-2221
Mailing Address - Fax:218-739-5501
Practice Address - Street 1:615 S MILL ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2756
Practice Address - Country:US
Practice Address - Phone:218-739-2221
Practice Address - Fax:218-739-5501
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46990208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1041963OtherPREFERRED ONE NUMBER
MN132318OtherU-CARE NUMBER
OR091256Medicaid
MN3700042OtherMEDICA NUMBER
NE41091744413Medicaid
MN485T3HAOtherBCBS NUMBER
ND13656Medicaid
MN485T3HAOtherBCBS NUMBER
MN1041963OtherPREFERRED ONE NUMBER