Individual
MR. DENNIS R HASLAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11801 S. FREEWAY, FORT WORTH, TX 76134
(817) 293-9110
Mailing address
303 B NORTH EASTERN, KEENE, TX 76059
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M1746
TX
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
M1746
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176681801
—
TX
Enumeration date
04/18/2006
Last updated
06/21/2010
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