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General NPI Number Information
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NPI Number | 1679568182
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Entity Type | Individual
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Provider Name | LESTER N HAUGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 2416 LYNNDALE RD SUITE 110
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5252
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Country | US
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Telephone | 941-752-1900
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Fax | 941-752-1905
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Provider Business Mailing Address
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Address Line | 1790 GARDENIA ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1980
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Country | US
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Telephone | 941-752-1900
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Fax | 941-752-1905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | ME78635
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License Number State | FL
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