Provider Demographics
NPI:1467439653
Name:HAAS, BRADLEY N (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:N
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 MERGANSER CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-7970
Mailing Address - Country:US
Mailing Address - Phone:720-480-5710
Mailing Address - Fax:
Practice Address - Street 1:4567 MERGANSER CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-7970
Practice Address - Country:US
Practice Address - Phone:720-480-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35956207L00000X
FLME158988207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113572400Medicaid
KS100312690AMedicaid
NE84113438513Medicaid
CO01359561Medicaid
MT3506685Medicaid
NMT4723Medicaid
KS100312690AMedicaid
WY113572400Medicaid
CO01359561Medicaid