Provider Demographics
NPI:1750777421
Name:HAAS, KEITA M (IDMT)
Entity type:Individual
Prefix:MS
First Name:KEITA
Middle Name:M
Last Name:HAAS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:KEITA
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:USAF IDMT
Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-404-1142
Mailing Address - Fax:
Practice Address - Street 1:31ST MEDICAL GROUP/SGST
Practice Address - Street 2:UNIT 6180
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09604-6180
Practice Address - Country:US
Practice Address - Phone:314-632-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians