Provider Demographics
NPI:1518066539
Name:NAUTA, HARING JW (MD)
Entity Type:Individual
Prefix:
First Name:HARING
Middle Name:JW
Last Name:NAUTA
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 1:5138 55TH STREET CIR W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-4923
Mailing Address - Country:US
Mailing Address - Phone:409-599-7551
Mailing Address - Fax:
Practice Address - Street 1:5138 55TH STREET CIR W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-4923
Practice Address - Country:US
Practice Address - Phone:409-599-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2443207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125246203Medicaid
TX125246203Medicaid
TXB63395Medicare UPIN