Healthcare Provider Details

I. General information

NPI: 1891756805
Provider Name (Legal Business Name): KARL TRACY HAGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DR W H BLAKE JR DR
MUSCLE SHOALS AL
35661-2152
US

IV. Provider business mailing address

101 DR W H BLAKE JR DR
MUSCLE SHOALS AL
35661-2152
US

V. Phone/Fax

Practice location:
  • Phone: 256-381-1001
  • Fax: 256-381-3604
Mailing address:
  • Phone: 256-381-1001
  • Fax: 256-381-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number00023775
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: