Provider Demographics
NPI:1871820837
Name:HAUG, SARA JOY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JOY
Last Name:HAUG
Suffix:
Gender:F
Credentials:MD, PHD
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 2870
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-2870
Mailing Address - Country:US
Mailing Address - Phone:970-828-2200
Mailing Address - Fax:
Practice Address - Street 1:2300 E 30TH ST
Practice Address - Street 2:STE B-105
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8991
Practice Address - Country:US
Practice Address - Phone:970-828-2200
Practice Address - Fax:970-828-2201
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0056814207W00000X, 207WX0107X
NMMD2016-0574207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68205325Medicaid
CO10270078Medicaid
NM68205325Medicaid