Individual
WILLIAM T HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1200 S ROGERS ST, BLOOMINGTON, IN 47403-4792
(812) 339-6434
Mailing address
1200 S ROGERS ST, BLOOMINGTON, IN 47403-4792
(812) 339-6434
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
009943
NY
363AM0700X
Medical Physician Assistant
Primary
10000917A
IN
Other
Enumeration date
08/25/2005
Last updated
11/13/2024
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