Healthcare Provider Details

I. General information

NPI: 1659313708
Provider Name (Legal Business Name): JOHN BRUCE HAGGARTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

248 PLEASANT ST SUITE 2600
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 603-227-7140
  • Fax: 603-227-7187
Mailing address:
  • Phone: 603-228-7400
  • Fax: 603-228-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9699
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: