Provider Demographics
NPI:1144207440
Name:HAULER, JENNIFER (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAULER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8280 YANKEE ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1806
Mailing Address - Country:US
Mailing Address - Phone:937-436-4658
Mailing Address - Fax:
Practice Address - Street 1:8701 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1066
Practice Address - Country:US
Practice Address - Phone:937-558-3338
Practice Address - Fax:937-558-3349
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008335207P00000X, 146D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2599013Medicaid
OH4254842OtherMEDICARE PTAN
OH4167711OtherMEDICARE PTAN
OH4167711OtherMEDICARE PTAN
OH4254842OtherMEDICARE PTAN
OH4167716Medicare PIN