Provider Demographics
NPI:1699779074
Name:HAUPTMAN, RONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:HAUPTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 E CAMELBACK RD
Mailing Address - Street 2:STE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4418
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:#2015
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2437
Practice Address - Country:US
Practice Address - Phone:602-279-3575
Practice Address - Fax:602-279-2666
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78697301Medicaid
AZ110639OtherMEDICARE PIN NUMBER FOR N
AZ110639OtherMEDICARE PIN NUMBER FOR N
75097Medicare ID - Type Unspecified