Active NPI
Dirk Francis Havlak, MD
- Family Medicine Physician
- Lacey, WA
National Provider Identifier
1003989260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00020629
- Practice address
- 5130 Corporate Center CT SE
Lacey, WA 98503-5957 - Phone
- (360) 413-8600
- NPI assigned
- Nov 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00020629 | WA | Primary |
Addresses
Primary practice location
5130 Corporate Center CT SE
Lacey, WA 98503-5957
Mailing address
1613 Camden Cir SW
Olympia, WA 98512-5552
Phone (360) 943-2734
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8546905 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00020629 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1003989260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1613 CAMDEN CIR SW",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985125552",
"telephone_number": "360-943-2734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5130 CORPORATE CENTER CT SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985035957",
"telephone_number": "360-413-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVLAK",
"first_name": "DIRK",
"middle_name": "FRANCIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-16",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00020629",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8546905",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.