Provider Demographics
NPI:1598709339
Name:HAAS, GILBERT G JR (MD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:G
Last Name:HAAS
Suffix:JR
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 1:431 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1924
Mailing Address - Country:US
Mailing Address - Phone:405-524-7812
Mailing Address - Fax:
Practice Address - Street 1:431 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1924
Practice Address - Country:US
Practice Address - Phone:405-524-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEME14641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522098Medicare PIN
OKE16474Medicare UPIN