Basic Information
Provider Information
NPI: 1003803602
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAUGER
FirstName: KIM
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4111 S DARLINGTON AVE
Address2: SUITE 700
City: TULSA
State: OK
PostalCode: 741356348
CountryCode: US
TelephoneNumber: 9187438838
FaxNumber: 9187439058
Practice Location
Address1: 4111 S DARLINGTON AVE
Address2: STE 700
City: TULSA
State: OK
PostalCode: 741356348
CountryCode: US
TelephoneNumber: 9187438838
FaxNumber: 9187439058
Other Information
ProviderEnumerationDate: 09/29/2005
LastUpdateDate: 12/20/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X15635OKY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
30001909801OKRAILROAD MEDICAREOTHER
100112790A05OK MEDICAID
30012967601OKRAILROAD MEDICAREOTHER


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