Provider Demographics
NPI:1699836189
Name:HALLAUER, WOLFGANG CURT (MD)
Entity Type:Individual
Prefix:
First Name:WOLFGANG
Middle Name:CURT
Last Name:HALLAUER
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 1:2011 ALAMO PINTADO RD
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-9749
Mailing Address - Country:US
Mailing Address - Phone:805-688-2911
Mailing Address - Fax:805-688-0062
Practice Address - Street 1:185 W HIGHWAY 246 STE 102
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9458
Practice Address - Country:US
Practice Address - Phone:805-686-8555
Practice Address - Fax:805-686-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA14978208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A149780Medicaid
CAA14978Medicare ID - Type Unspecified
CAA19958Medicare UPIN