Individual
JASON P HAACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
191 OVERTHRUST RD, EVANSTON, WY 82930-9261
(307) 789-8721
(307) 789-8664
Mailing address
191 OVERTHRUST RD, EVANSTON, WY 82930-9261
(307) 789-8721
(307) 789-8664
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
7953A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06329001
BCBS WY
WY
05
—
1407832728
—
WY
05
—
433920700
—
MN
Enumeration date
12/19/2005
Last updated
03/15/2017
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