Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DN21896 | FL |
N | 213EG0000X | General Practice | DN21896 | FL |
Y | 1223P0300X | Periodontist | DN21896 | FL |
NPI | 1063871804 |
---|---|
Provider Name | Dr. Ross Andrew Hauer |
First Address | Boca Raton, FL 33432-6181 |
Second Address | Port Saint Lucie, FL 34986-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2016 |
Last Update Date | 02/06/2021 |