Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | OS002854L | PA |
NPI | 1013193663 |
---|---|
Provider Name | William Allen Haug III |
First Address | Pottstown, PA 19464-6439 |
Second Address | Pottstown, PA 19464-6439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 07/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C32554 | (02) | PA |