Individual
PAUL DAVID HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
912 MAIN STREET, LITTLEFORK, MN 56653-9357
(218) 278-6634
(218) 278-6637
Mailing address
912 MAIN STREET, LITTLEFORK, MN 56653-9357
(218) 278-6634
(218) 278-6637
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24789
MN
207Q00000X
Family Medicine Physician
8194
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0020-14029
—
NV
05
—
2014029
—
NV
Enumeration date
11/15/2005
Last updated
04/29/2010
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