Provider Demographics
NPI:1326253758
Name:HAUSE, DONALD (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:HAUSE
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 1:3 PARKCENTER DR
Mailing Address - Street 2:#150
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5400
Mailing Address - Country:US
Mailing Address - Phone:916-646-6869
Mailing Address - Fax:916-646-3507
Practice Address - Street 1:3 PARKCENTER DR
Practice Address - Street 2:#150
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-646-6869
Practice Address - Fax:916-646-3507
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist