Healthcare Provider Details

I. General information

NPI: 1104838184
Provider Name (Legal Business Name): BRYAN SCOTT HAUSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST VA CLINIC
SACO ME
04072
US

IV. Provider business mailing address

62 STORER ST
KENNEBUNK ME
04043
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-3100
  • Fax: 207-286-3709
Mailing address:
  • Phone: 207-985-9129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11699
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: