Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 63465 | GA |
NPI | 1013173137 |
---|---|
Provider Name | Dr. Frederick Allen Hauser JR. |
First Address | Kennedy Space Center, FL 32899 |
Second Address | Kennedy Space Center, FL 32899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 20/09/2021 |