Provider Demographics
NPI:1336256684
Name:HABER, JEFFREY I (MDPA)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:HABER
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW 126TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5414
Mailing Address - Country:US
Mailing Address - Phone:954-344-8170
Mailing Address - Fax:954-344-5276
Practice Address - Street 1:1801 NW 126TH WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5414
Practice Address - Country:US
Practice Address - Phone:954-344-8170
Practice Address - Fax:954-344-5276
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48510207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048848800Medicaid
FL048848800Medicaid