Healthcare Provider Details

I. General information

NPI: 1497946974
Provider Name (Legal Business Name): MARION L. HAGAN M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 S MAPLE ST
FRENCH LICK IN
47432-2245
US

IV. Provider business mailing address

567 S MAPLE ST
FRENCH LICK IN
47432-2245
US

V. Phone/Fax

Practice location:
  • Phone: 812-936-4515
  • Fax: 812-936-4536
Mailing address:
  • Phone: 812-936-4515
  • Fax: 812-936-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01019427
License Number StateIN

VIII. Authorized Official

Name: DR. MARION L. HAGAN
Title or Position: PHYSICIAN/ OWNER
Credential: M.D.
Phone: 812-936-4515