Basic Information
| Provider Information | |||||||||
| NPI: | 1306821699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAUSER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | W349S4884 KINGDOM DR | ||||||||
| Address2: | |||||||||
| City: | DOUSMAN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531189796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629653911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 129 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530983384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202624800 | ||||||||
| FaxNumber: | 9202624813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 14823 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 30949300 | 05 | WI | MEDICAID | AH4055100 | 01 | DEA | OTHER |