Healthcare Provider Details

I. General information

NPI: 1588827422
Provider Name (Legal Business Name): DANIEL R HAGEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

2609 GLENN HENDREN DR
LIBERTY MO
64068-3313
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-0396
  • Fax:
Mailing address:
  • Phone: 816-407-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101016380
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2009016633
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: