Healthcare Provider Details

I. General information

NPI: 1639124092
Provider Name (Legal Business Name): RUSTI T HAUGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 GUHN RD
HOUSTON TX
77040-6161
US

IV. Provider business mailing address

5500 GUHN RD
HOUSTON TX
77040-6161
US

V. Phone/Fax

Practice location:
  • Phone: 713-783-8889
  • Fax: 713-953-0471
Mailing address:
  • Phone: 713-783-8889
  • Fax: 713-953-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberL4129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: