Individual
ERIC C HAAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4707 RIO ST, FARMINGTON, NM 87402-5323
(505) 787-9035
Mailing address
4707 RIO ST, FARMINGTON, NM 87402-5323
(505) 787-9035
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
332
NM
213EP1101X
Primary Podiatric Medicine Podiatrist
POD332
NM
213ES0131X
Foot Surgery Podiatrist
POD332
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Q1443
INDIVIDUAL MEDICARE PTAN
NM
01
—
6N8581
GROUP MEDICARE PTAN
NM
05
—
74122355
—
NM
Enumeration date
11/04/2008
Last updated
08/23/2024
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