Provider Demographics
NPI:1750390100
Name:HAUSER, DAVID RAY
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RAY
Last Name:HAUSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4888 WHITEFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2810
Mailing Address - Country:US
Mailing Address - Phone:419-885-5563
Mailing Address - Fax:419-885-5439
Practice Address - Street 1:4888 WHITEFORD ROAD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2810
Practice Address - Country:US
Practice Address - Phone:419-885-5563
Practice Address - Fax:419-885-5439
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002085213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0519237Medicaid
OHP00270288OtherRAILROAD MEDICARE
OH0519237Medicaid
OHP00270288OtherRAILROAD MEDICARE