Dr. John Michael Hautala
Adolescent Medicine
1033 Regents Blvd Suite 102
Fircrest
, Washington 98466-6045
Dr. John Michael Hautala
Adolescent Medicine
1033 Regents Blvd Suite 102
Fircrest
, Washington 98466-6045
(253) 565-4552
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Dr. John Michael Hautala
- 1033 Regents Blvd Suite 102
- Fircrest, WA
- Zip : 98466-6045
- Fax : (253) 565-4552
- Phone : (253) 564-1115
Second Address
- Dr. John Michael Hautala
- 1033 Regents Blvd Suite 102
- Fircrest, WA
- Zip : 98466-6045
- Fax : (253) 565-4552
- Phone : (253) 564-1115
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | MD00019059 | WA |
National Provider Identifier
| NPI | 1174664130 |
|---|---|
| Provider Name | Dr. John Michael Hautala |
| First Address | Fircrest, WA 98466-6045 |
| Second Address | Fircrest, WA 98466-6045 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/02/2007 |
| Last Update Date | 15/01/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 108917 | L&I NUMBER (01) | WA |
| 1783703 | (05) | WA |
| AH1062239 | DEA NUMBER (01) | WA |
| E57821 | (02) | WA |
| HA7840 | REGENCE BLUE SHIELD (01) | WA |
| MD00019059 | STATE LICENSE NUMBER (01) | WA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.