Provider Demographics
NPI:1326212234
Name:R SCOTT HAUPT MD PC
Entity type:Organization
Organization Name:R SCOTT HAUPT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-293-8100
Mailing Address - Street 1:5292 COLLEGE DR
Mailing Address - Street 2:#302
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2672
Mailing Address - Country:US
Mailing Address - Phone:801-293-8100
Mailing Address - Fax:
Practice Address - Street 1:5292 COLLEGE DR
Practice Address - Street 2:#302
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2672
Practice Address - Country:US
Practice Address - Phone:801-293-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2742511205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000057295Medicare PIN