Healthcare Provider Details

I. General information

NPI: 1275875973
Provider Name (Legal Business Name): JAMES CLARK HAUG D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6057 GRIFFIN DR
COLORADO SPRINGS CO
80924-7027
US

IV. Provider business mailing address

22100 BOTHELL EVERETT HWY
BOTHELL WA
98021-8431
US

V. Phone/Fax

Practice location:
  • Phone: 208-416-2932
  • Fax: 855-687-7237
Mailing address:
  • Phone: 208-416-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0060259
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: