Provider Demographics
NPI:1083295927
Name:HAQUE, MUSHAF SYED (DO, MS)
Entity type:Individual
Prefix:DR
First Name:MUSHAF
Middle Name:SYED
Last Name:HAQUE
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:ST. JOSEPH'S MEDICAL CENTER
Mailing Address - Street 2:1717 SOUTH J. STREET
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-426-4101
Mailing Address - Fax:
Practice Address - Street 1:ST. JOSEPH'S MEDICAL CENTER
Practice Address - Street 2:1717 SOUTH J STREET
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:315-436-8331
Practice Address - Fax:817-927-6171
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP61562353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty