Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | MD60367839 | WA |
NPI | 1033377973 |
---|---|
Provider Name | Matthew J Hauck |
First Address | Vancouver, WA 98664-4896 |
Second Address | Vancouver, WA 98686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2013026 | (05) | WA |