Provider Demographics
NPI:1780758227
Name:HAGGART, MARIE SOUTH (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SOUTH
Last Name:HAGGART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:HAGGART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1992 W ANTELOPE DR
Mailing Address - Street 2:2B
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4953
Mailing Address - Country:US
Mailing Address - Phone:801-776-4444
Mailing Address - Fax:
Practice Address - Street 1:1992 W ANTELOPE DR
Practice Address - Street 2:2B
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4953
Practice Address - Country:US
Practice Address - Phone:801-776-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50224741205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine