Provider Demographics
NPI:1043345366
Name:HAUGEN, PERRY ALLAN (MD)
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:ALLAN
Last Name:HAUGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 SYLVA LN STE G
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-0340
Mailing Address - Fax:209-532-6405
Practice Address - Street 1:940 SYLVA LN STE G
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-0340
Practice Address - Fax:209-532-6405
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85829207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G858291Medicaid
CA1299310002OtherSECOND DEMERC PIN
CA00G858290Medicaid
CA180040947OtherRAILROAD MEDICARE PIN
CAF24119Medicare UPIN
CA180040947OtherRAILROAD MEDICARE PIN
CA00G858290Medicaid
CA1299310001OtherFIRST DEMERC PIN
CA00G858290Medicare PIN
CA1299310002Medicare PIN
CA942593611OtherFEIN