Provider Demographics
NPI:1790792265
Name:HAUGE, CHRISTOPHER W (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:HAUGE
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 1:3907 CREEKSIDE LOOP
Mailing Address - Street 2:SUITE 130
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4879
Mailing Address - Country:US
Mailing Address - Phone:509-225-4555
Mailing Address - Fax:509-225-4554
Practice Address - Street 1:3907 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 130
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4879
Practice Address - Country:US
Practice Address - Phone:509-225-4555
Practice Address - Fax:509-225-4554
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000134152086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1108943Medicaid
WA1108943Medicaid
WAAB39114Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER