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1104402767 NPI number — SAMUEL ELHARDT HAGER DO

NPI Number: 1104402767
Health Care Provider/Practitioner: SAMUEL ELHARDT HAGER DO

Information about “1104402767” NPI (SAMUEL ELHARDT HAGER DO) exists in 1104402767 in HTML format HTML  |  1104402767 in plain Text format TXT  |  1104402767 in PDF (Portable Document Format) PDF  |  1104402767 in an XML format XML  formats.

NPI Number : 1104402767 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104402767",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HAGER",
    "FirstName": "SAMUEL",
    "MiddleName": "ELHARDT",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4686 N WILDFLOWERS WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CASTLE ROCK",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80109-8400",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "701-202-6619",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8401 S CHAMBERS RD # A-11",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ENGLEWOOD",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80112-3276",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "720-874-2420",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/23/2021",
    "LastUpdateDate": "02/03/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "204D00000X",
        "TaxonomyName": "Neuromusculoskeletal Medicine & OMM Physician",
        "LicenseNumber": "DR.0070052",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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