Provider Demographics
NPI:1851389878
Name:HAUPT, DAVID JEFFREY (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JEFFREY
Last Name:HAUPT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 706
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7661
Mailing Address - Country:US
Mailing Address - Phone:949-706-3838
Mailing Address - Fax:949-706-9726
Practice Address - Street 1:400 NEWPORT CENTER DR STE 706
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7661
Practice Address - Country:US
Practice Address - Phone:949-706-3838
Practice Address - Fax:949-706-9726
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3988213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000839880Medicaid
CA000839880Medicaid
E3988Medicare ID - Type Unspecified