MEDICARE: MR. DENVER H HAGER PA-C

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	363A00000X	Physician Assistant	1063	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568449668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENVER H HAGER PA-C

Provider Business Mailing Address
First Line	:	506 RIDGE RD
Second Line	:
City	:	DIVIDE
State	:	CO
Zip	:	80814-9635
Country	:	US
Telephone Number	:	719-332-3097
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 HIGHWAY 105
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-9045
Country	:	US
Telephone Number	:	719-419-8002
Fax Number	:	719-419-8003

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/10/2022

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