Individual
SHADI MAHER HADDADIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 556-7718
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 556-5757
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
2008003781
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073611919
—
MO
01
—
431560263
TRICARE WEST
MO
01
—
P00724818
RAILROAD MEDICARE
MO
Enumeration date
09/21/2006
Last updated
12/10/2014
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