Basic Information
| Provider Information | |||||||||
| NPI: | 1467424408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAAS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ADOLF | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4211 VAN DYKE RD STE 101B | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335588005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139604026 | ||||||||
| FaxNumber: | 8134438166 | ||||||||
| Practice Location | |||||||||
| Address1: | 4211 VANDYKE ROAD | ||||||||
| Address2: | SUITE 101B | ||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335588005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139604026 | ||||||||
| FaxNumber: | 8139604489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME78965 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 257253200 | 05 | FL | MEDICAID |