Individual
SANJAY HAVALDAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3901 S FREMONT AVE, SPRINGFIELD, MO 65804-6538
(417) 875-3000
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
116190
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114559
BLUE CROSS/BLUE SHIELD
—
05
—
203834106
—
MO
Enumeration date
06/14/2006
Last updated
01/15/2021
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