MEDICARE: DR. LESTER N HAUGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LA0401X	Addiction Medicine (Anesthesiology) Physician	ME78635	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58706	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679568182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESTER N HAUGE M.D.

Provider Business Mailing Address
First Line	:	1790 GARDENIA ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1980
Country	:	US
Telephone Number	:	941-752-1900
Fax Number	:	941-752-1905

Provider Business Practice Location Address
First Line	:	2416 LYNNDALE RD
Second Line	:	SUITE 110
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-5252
Country	:	US
Telephone Number	:	941-752-1900
Fax Number	:	941-752-1905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/10/2008

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Directions to “ DR. LESTER N HAUGE M.D.” Practice Location

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