Provider Demographics
NPI:1679568182
Name:HAUGE, LESTER N (MD)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:N
Last Name:HAUGE
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 1:1790 GARDENIA ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1980
Mailing Address - Country:US
Mailing Address - Phone:941-752-1900
Mailing Address - Fax:941-752-1905
Practice Address - Street 1:2416 LYNNDALE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5252
Practice Address - Country:US
Practice Address - Phone:941-752-1900
Practice Address - Fax:941-752-1905
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78635207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58706OtherBLUE CROSS BLUE SHIELD
FLE10836Medicare UPIN
FLE4484ZMedicare ID - Type Unspecified