Provider Demographics
NPI:1760490510
Name:HAUT, LEWIS L (MD)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:L
Last Name:HAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2039 FOREST AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-998-8800
Mailing Address - Fax:408-998-2926
Practice Address - Street 1:2039 FOREST AVE
Practice Address - Street 2:STE 301
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-998-8800
Practice Address - Fax:408-998-2926
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG362310207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G362310Medicaid
CA00G362310Medicaid
CA00G362310Medicare ID - Type Unspecified