Healthcare Provider Details

I. General information

NPI: 1700717543
Provider Name (Legal Business Name): DAVID HAGSTROM, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8214 MILWAUKEE AVE
LUBBOCK TX
79424-0923
US

IV. Provider business mailing address

3107 77TH ST
LUBBOCK TX
79423-1807
US

V. Phone/Fax

Practice location:
  • Phone: 806-438-4452
  • Fax: 806-795-1528
Mailing address:
  • Phone: 806-438-4452
  • Fax: 806-795-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID KEITH HAGSTROM
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 806-438-4452