Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | MD00040450 | WA |
NPI | 1366404592 |
---|---|
Provider Name | Eric E Haeger |
First Address | Brewster, WA 98812-1092 |
Second Address | Brewster, WA 98812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 17/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8414625 | (05) | WA |
G92819 | (02) | WA |