DR. JOHN MICHAEL HAUTALA (NPI# 1174664130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174664130 |
| Entity Type | Individual |
| Full Name | DR. JOHN MICHAEL HAUTALA |
| Credential | M.D. |
| Practice Address |
1033 Regents Blvd Suite 102 Fircrest WA 98466-6045 |
| Practice Telephone | 2535641115 |
| Practice Fax Number | 2535654552 |
| Mailing Telephone | 2535641115 |
| Mailing Fax Number | 2535654552 |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2014-01-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
MD00019059 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | STATE LICENSE NUMBER | MD00019059 | 01 |
| WA | L&I NUMBER | 108917 | 01 |
| WA | 1783703 | 05 | |
| WA | DEA NUMBER | AH1062239 | 01 |
| WA | REGENCE BLUE SHIELD | HA7840 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144276981 | John William Hautala | Emergency Medicine | 901 Mountain View Dr, Shelton, WA 98584-4401 | 2006-05-25 |
| Street Address |
1033 REGENTS BLVD SUITE 102 |
| City | FIRCREST |
| State | WA |
| Zip Code | 98466-6045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245217256 | Paul E Debusschere | Pediatrics | 1033 Regents Blvd, Suite 102, Fircrest, WA 98466-6045 | 2005-12-30 |
| 1245508498 | Kyle S Bristow | Massage Therapist | 1033 Regents Blvd, Suite 204, Fircrest, WA 98466-6045 | 2011-12-02 |
| 1386977148 | Austin D Mcmillin Dc Ps | Chiropractor | 1033 Regents Blvd, Ste. 204, Fircrest, WA 98466-6045 | 2009-09-11 |
| 1316191885 | James P. Gagliardi, Dds, Ps | Clinic/Center | 1033 Regents Blvd, Suite 201, Fircrest, WA 98466-6045 | 2008-11-11 |
| 1316128523 | Kariah C Phillips | Social Worker | 1033 Regents Blvd, Ste 101, Fircrest, WA 98466-6089 | 2007-11-15 |
| 1033250113 | Bruce Gerard Davies | Pediatrics | 1033 Regents Blvd, Suite 102, Fircrest, WA 98466-6045 | 2007-02-09 |
| 1053452607 | Belinda Shunk Rone | Pediatrics | 1033 Regents Blvd, Suite 102, Fircrest, WA 98466-6045 | 2007-02-08 |
| 1043281165 | James Patrick Gagliardi | Dentist | 1033 Regents Blvd, Suite 201, Fircrest, WA 98466-6045 | 2006-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306499215 | Julie Mccartney | Counselor | 7610 40th St W Ste 20, University Place, WA 98466 | 2019-07-19 |
| 1033682752 | Jms Corporate Services Group | In Home Supportive Care | 2621 70th Avenue West, Suite C, University Place, WA 98466 | 2019-01-04 |
| 1992270243 | Kathleen Marie Kulman | Massage Therapist | 4113 Bridgeport Avenue, Suite B, Tacoma, WA 98466 | 2018-10-12 |
| 1518441674 | Michala Lin Dymond-shaw | Speech-Language Pathologist | 3725 Grandview Dr W, University Place, WA 98466 | 2018-09-24 |
| 1770001133 | Micky Patrick Cates | Physician Assistant | 1924 70th Ave West, Apt E5, University Place, WA 98466 | 2017-09-06 |
| 1386160984 | Stephanie Herrala | Dentist | Okubo Dental Clinic 11582 C St, Jblm, WA 98466 | 2017-08-16 |
| 1033581640 | Jay Hyuck Sung | Dentist | 3670 Bridgeport Way W, Unit B, University Place, WA 98466 | 2015-10-22 |
| 1174951867 | Adrienne Holliday | Occupational Therapy Assistant | 3717 Grandview Drive W, University Place, WA 98466 | 2013-10-16 |
| 1598106650 | Maricris Pang Espino | Registered Nurse | 1541 Cottonwood Avenue, Fircrest, WA 98466 | 2013-07-17 |
| 1417393653 | Nurhan Karakas | Counselor | 9330 59th Ave Sw, Lakewood, WA 98466 | 2013-05-15 |
| Find all providers in zip 98466 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720498280 | Rainier Pediatrics, Inc | Pediatrics | 12904 94th Ave E, Puyallup, WA 98373-5538 | 2014-05-05 |
| 1568675544 | Robert Michael Lehman | Pediatrics | 1545 Nw 57th St, #522, Seattle, WA 98107-5643 | 2007-05-07 |
| 1134343676 | Michael Donlan | Pediatrics | 7103 N Skyline Dr, Spokane, WA 99208-6717 | 2007-04-13 |
| 1508927062 | David Alan Springer | Pediatrics | 4005 Wallingford Ave N, Seattle, WA 98103-8218 | 2006-12-12 |
| 1730247073 | Mohinder Singh Badyal | Pediatrics | 32124 1st Ave S, Ste100, Federal Way, WA 98003-5761 | 2006-12-05 |
| 1396813218 | Penny Russell Tronolone | Pediatrics | Echo Glen Children's Center, 33010 Se 99th St, Snoqualmie, WA 98065 | 2006-11-30 |
| 1164508792 | Deborah J Ayars | Pediatrics | 1901 S Union Ave Ste B1010, Tacoma, WA 98405-1801 | 2006-10-27 |
| 1922027168 | Tania Milad Matta | Pediatrics | 3950 Keene Road, West Richland, WA 99353 | 2006-07-19 |
| 1629025333 | Public Hospital District #1 of King County | Pediatrics | 6920 Coal Creek Pkwy Se, Ste 12, Newcastle, WA 98059-3147 | 2006-05-28 |
| 1861468720 | Gina Suzanne Sucato | Pediatrics | 13451 Se 36th St, Bellevue, WA 98006-1475 | 2006-02-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.