Provider Demographics
NPI:1366578510
Name:HAGUE, DOUGLAS ALLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:HAGUE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 V ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1825
Mailing Address - Country:US
Mailing Address - Phone:916-838-1812
Mailing Address - Fax:916-452-3139
Practice Address - Street 1:2431 V ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1825
Practice Address - Country:US
Practice Address - Phone:916-838-1812
Practice Address - Fax:916-452-3139
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3445213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00691036OtherRAIL ROAD MEDICARE INDIVIDUAL PTAN
CA000E34450Medicaid
CAAN117ZMedicare PIN
CAT11693Medicare UPIN
CACS9721Medicare PIN