Organization
IDAHO CENTER FOR REGENERATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J HAAKE D.O. (PHYSICIAN)
(208) 995-2802
Entity
Organization
Contact information
Practice address
868 E RIVERSIDE DR, SUITE 170, EAGLE, ID 83616-5412
(208) 995-2802
(208) 995-2804
Mailing address
868 E RIVERSIDE DR, SUITE 170, EAGLE, ID 83616-5412
(208) 995-2802
(208) 995-2804
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207R00000X
ID
Other
Enumeration date
03/19/2014
Last updated
03/17/2016
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