Provider Demographics
NPI:1508877119
Name:HAUPT, RUSSELL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:SCOTT
Last Name:HAUPT
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 1:5292 COLLEGE DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2672
Mailing Address - Country:US
Mailing Address - Phone:801-293-8100
Mailing Address - Fax:801-293-8101
Practice Address - Street 1:5292 COLLEGE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2672
Practice Address - Country:US
Practice Address - Phone:801-293-8100
Practice Address - Fax:801-293-8101
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274251-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000011726Medicare ID - Type Unspecified
UTG22298Medicare UPIN