MEDICARE: DR. RONALD J HAUPTMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	21316	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110639	OTHER	AZ	MEDICARE PIN NUMBER FOR N

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699779074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD J HAUPTMAN MD

Provider Business Mailing Address
First Line	:	3020 E CAMELBACK RD
Second Line	:	STE 301
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4418
Country	:	US
Telephone Number	:	602-264-9100
Fax Number	:	602-264-9101

Provider Business Practice Location Address
First Line	:	9250 N 3RD ST
Second Line	:	#2015
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2437
Country	:	US
Telephone Number	:	602-279-3575
Fax Number	:	602-279-2666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/07/2019

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