Provider Demographics
NPI:1871905844
Name:HAGUE, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18406 N 96TH DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-1721
Mailing Address - Country:US
Mailing Address - Phone:623-810-0049
Mailing Address - Fax:
Practice Address - Street 1:18406 N 96TH DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1721
Practice Address - Country:US
Practice Address - Phone:623-810-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15412246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology