Provider Demographics
NPI:1255357620
Name:HAUPT, KURT (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:HAUPT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 CASA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1883
Mailing Address - Country:US
Mailing Address - Phone:805-544-8811
Mailing Address - Fax:805-548-0777
Practice Address - Street 1:35 CASA ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1818
Practice Address - Country:US
Practice Address - Phone:805-786-4111
Practice Address - Fax:805-543-6357
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG46037207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G460370Medicaid
CAGR0092200Medicaid
CAGR0092200Medicaid
CA00G460370Medicaid