Provider Demographics
NPI:1598979114
Name:HAUCK, JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:HAUCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602-0431
Mailing Address - Country:US
Mailing Address - Phone:253-651-0824
Mailing Address - Fax:
Practice Address - Street 1:4430 PO VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:FT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5134
Practice Address - Country:US
Practice Address - Phone:315-772-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant