Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5999 | NE |
NPI | 1023130036 |
---|---|
Provider Name | Dr. John W Haugen |
First Address | North Platte, NE 69101-6532 |
Second Address | North Platte, NE 69101-6532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025226600 | (05) | NE |