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General NPI Number Information
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NPI Number | 1902042765
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Entity Type | Individual
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Provider Name | CAYLON W. HAGGARD PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 903 S ADAMS ST
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City | RITZVILLE
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State | WA
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Zip | 99169-2227
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Country | US
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Telephone | 96-591-2005
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Fax | 509-659-0632
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Provider Business Mailing Address
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Address Line | 411 FORTUYN RD
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City | GRAND COULEE
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State | WA
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Zip | 99133-8718
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Country | US
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Telephone | 509-633-1911
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Fax | 509-633-1933
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 1787
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1787
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61041209
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License Number State | WA
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