Healthcare Provider Details

I. General information

NPI: 1952568602
Provider Name (Legal Business Name): JOSHUA DENNIS HAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 FRIST BLVD STE 5
FORT PIERCE FL
34950-4800
US

IV. Provider business mailing address

2401 FRIST BLVD STE 5
FORT PIERCE FL
34950-4800
US

V. Phone/Fax

Practice location:
  • Phone: 772-241-6330
  • Fax:
Mailing address:
  • Phone: 772-241-6330
  • Fax: 772-241-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME115394
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME115394
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME115394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: