Provider Demographics
NPI:1083643498
Name:HAUGEN, JOEL R (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:HAUGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3902 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3357
Practice Address - Country:US
Practice Address - Phone:701-364-6600
Practice Address - Fax:701-364-6628
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4721207Q00000X
MN25433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND100030OtherLHS #
ND3T637HAOtherMNBS #
ND644307900Medicaid
ND63D98HAOtherMNBS #
ND0106129OtherMEDICA #
ND14615Medicaid
ND1735OtherNDBS #
NDHP19503OtherHEALTHPARTNERS #
ND0118705OtherMEDICA #
ND06004HAOtherMNBS #
NDDA9011015641OtherPREFERRED ONE #
ND169317OtherUCARE #
ND63322HAOtherMNBS #
MN6438OtherNDBS #
ND676596OtherAMERICA'S PPO/ARAZ #
ND644307900Medicaid
NDDA9011015641OtherPREFERRED ONE #
ND169317OtherUCARE #
ND14615Medicaid
ND3T637HAOtherMNBS #