Healthcare Provider Details

I. General information

NPI: 1104402767
Provider Name (Legal Business Name): SAMUEL ELHARDT HAGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 S CHAMBERS RD # A-11
ENGLEWOOD CO
80112-3276
US

IV. Provider business mailing address

4686 N WILDFLOWERS WAY
CASTLE ROCK CO
80109-8400
US

V. Phone/Fax

Practice location:
  • Phone: 720-874-2420
  • Fax:
Mailing address:
  • Phone: 701-202-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDR.0070052
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: