Provider Demographics
NPI:1134154032
Name:HAGGARD, STEPHEN (DPM PS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HAGGARD
Suffix:
Gender:M
Credentials:DPM PS
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 506
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-0506
Mailing Address - Country:US
Mailing Address - Phone:253-661-5686
Mailing Address - Fax:253-815-1651
Practice Address - Street 1:210 27TH AVE APT F105
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-8330
Practice Address - Country:US
Practice Address - Phone:253-334-5262
Practice Address - Fax:253-815-1651
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000399213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG1000106734OtherPTAN
WATO1981Medicare UPIN
WAG1000106734OtherPTAN