Provider Demographics
NPI:1750574893
Name:HAGGQUIST, JEFFREY P (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:HAGGQUIST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 CONNECTICUT AVE NW STE 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2605
Mailing Address - Country:US
Mailing Address - Phone:202-244-8222
Mailing Address - Fax:
Practice Address - Street 1:5630 CONNECTICUT AVE NW STE 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2605
Practice Address - Country:US
Practice Address - Phone:202-244-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO0341942081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine