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Individual

MR. SHANE HAUPT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
L.M.P.

Contact information

Practice address
11701 NE 95TH ST STE C, VANCOUVER, WA 98682-2318
(360) 513-2654
Mailing address
3021 NE 72ND DR STE 9-63, VANCOUVER, WA 98661-7300
(360) 513-2654

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00020575
WA

Other

Enumeration date
10/13/2007
Last updated
10/13/2007
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