Provider Demographics
NPI:1093762106
Name:HAUGEN, SCOTT J (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
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 1:11511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8578
Mailing Address - Country:US
Mailing Address - Phone:425-502-3163
Mailing Address - Fax:425-502-3161
Practice Address - Street 1:11511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8578
Practice Address - Country:US
Practice Address - Phone:425-502-3163
Practice Address - Fax:425-502-3161
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39842174400000X
WAMD 00049311207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59879840Medicaid
WAG8881459OtherMEDICARE PIN
WA8543381Medicaid
WAG8881458OtherMEDICARE PIN
COH96499Medicare UPIN
CO804271Medicare ID - Type Unspecified