Basic Information
| Provider Information | |||||||||
| NPI: | 1659368496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAAS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | WILSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAAS | ||||||||
| OtherFirstName: | ROBERT | ||||||||
| OtherMiddleName: | WILSON | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2521 GLENN HENDREN DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640683388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167816066 | ||||||||
| FaxNumber: | 8167925130 | ||||||||
| Practice Location | |||||||||
| Address1: | 2521 GLENN HENDREN DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640683388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167816066 | ||||||||
| FaxNumber: | 8167925130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 34585 | MO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1396761334 | 01 | MO | LIBERTY ORTHOPEDIC ASSOCIATES, PC NPI | OTHER | 0388010001 | 01 | MO | DMERC | OTHER | 4750000 | 01 | MO | LIBERTY ORTHOPEDIC ASSOCIATES, PC PTAN | OTHER | 4753996 | 01 | MO | MEDICARE PTAN | OTHER | 200832301 | 05 | MO | MEDICAID |