Healthcare Provider Details

I. General information

NPI: 1922037100
Provider Name (Legal Business Name): DEAN R HAGNESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 STANLEY STREET
STEVENS POINT WI
54481-3112
US

IV. Provider business mailing address

900 ILLINOIS AVE
STEVENS POINT WI
54481-3112
US

V. Phone/Fax

Practice location:
  • Phone: 715-341-7332
  • Fax:
Mailing address:
  • Phone: 715-342-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23777
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: