Healthcare Provider Details

I. General information

NPI: 1750574893
Provider Name (Legal Business Name): JEFFREY P HAGGQUIST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 CONNECTICUT AVE NW STE 2
WASHINGTON DC
20015-2605
US

IV. Provider business mailing address

5630 CONNECTICUT AVE NW STE 2
WASHINGTON DC
20015-2605
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-8222
  • Fax:
Mailing address:
  • Phone: 202-244-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO034194
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: