Provider Demographics
NPI:1497772925
Name:HAUPT, DANIEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:HAUPT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:PSYCHIATRY UHN 80
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8144
Mailing Address - Fax:503-494-6152
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:PSYCHIATRY UHN 80
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8144
Practice Address - Fax:503-494-6152
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1132832084P0800X
ORMD1575662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204698914Medicaid
IL$$$$$$$$$Medicaid
IL$$$$$$$$$Medicaid
MO204698914Medicaid