Provider Demographics
NPI:1366404592
Name:HAEGER, ERIC E (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:HAEGER
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:PO BOX 1092
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-1092
Mailing Address - Country:US
Mailing Address - Phone:509-689-6666
Mailing Address - Fax:509-689-2330
Practice Address - Street 1:415 HOSPITAL WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812
Practice Address - Country:US
Practice Address - Phone:509-689-0100
Practice Address - Fax:509-689-0596
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040450146D00000X, 207QA0401X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8414625Medicaid
WAG92819Medicare UPIN
WA8414625Medicaid