Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIA-575 | ID |
NPI | 1013970698 |
---|---|
Provider Name | Dr. Robert W Haug |
First Address | Moscow, ID 83843-2842 |
Second Address | Moscow, ID 83843-2842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 04/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1672459 | (05) | ID |