Individual
DR. ROBERT JOHN HAAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
500 E SHORE DR, SUITE 100, EAGLE, ID 83616-6908
(208) 995-2802
(208) 995-2804
Mailing address
500 E SHORE DR, SUITE 100, EAGLE, ID 83616-6908
(208) 995-2802
(208) 995-2804
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
O-0520
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00155781
RAILROAD MEDICARE
IL
Enumeration date
08/12/2006
Last updated
07/16/2013
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