Individual
DR. BRIAN THOMAS HAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 863-1097
Mailing address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 863-1097
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
E6017
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
POD-001008
AZ
Other
Enumeration date
08/20/2018
Last updated
01/26/2024
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