Provider Demographics
NPI:1467664532
Name:WOLFGANG C HALLAUER
Entity Type:Organization
Organization Name:WOLFGANG C HALLAUER
Other - Org Name:BUELLTON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WOLFGANG
Authorized Official - Middle Name:CURT
Authorized Official - Last Name:HALLAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-686-8555
Mailing Address - Street 1:185 W. HWY 246
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427
Mailing Address - Country:US
Mailing Address - Phone:805-686-8555
Mailing Address - Fax:805-686-8556
Practice Address - Street 1:185 W. HWY 246
Practice Address - Street 2:SUITE 102
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427
Practice Address - Country:US
Practice Address - Phone:805-686-8555
Practice Address - Fax:805-686-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078780Medicaid