MEDICARE: BETTY ANN HAGAMAN I M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	75-18	NM
2	251V00000X	Voluntary or Charitable Agency	75-18	NM

General Provider Information

NPI Number	:	1033589601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY ANN HAGAMAN I M.D.

Provider Business Mailing Address
First Line	:	4810 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	253-278-8412
Fax Number	:

Provider Business Practice Location Address
First Line	:	4810 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	253-278-8412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	09/25/2015

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