=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124462171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEOFFREY BENJAMIN HAUGER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2013
-----------------------------------------------------
Last Update Date | 08/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 2ND AVE SW
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-540-7434
-----------------------------------------------------
Fax | 918-540-7473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5300 N INDEPENDENCE AVE STE 280
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-5555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-540-7434
-----------------------------------------------------
Fax | 915-540-7473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | BP10046326
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 33532
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------