Provider Demographics
NPI:1043416878
Name:U.S. AIR FORCE
Entity type:Organization
Organization Name:U.S. AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHO RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-292-5875
Mailing Address - Street 1:13807 RIVERBANK PASS
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3638
Mailing Address - Country:US
Mailing Address - Phone:210-292-5875
Mailing Address - Fax:210-292-5844
Practice Address - Street 1:WHMC GE 2200 BERGQUIST DR STE 1
Practice Address - Street 2:LACKLAND AFB
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-5300
Practice Address - Country:US
Practice Address - Phone:210-292-5875
Practice Address - Fax:210-292-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060712A286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital