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General NPI Number Information
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NPI Number | 1154493997
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Entity Type | Individual
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Provider Name | DAVID KEITH HAGSTROM MD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 710 E 6TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4655
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Country | US
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Telephone | 254-245-9175
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Fax | 254-213-7771
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Provider Business Mailing Address
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Address Line | PO BOX 610344
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City | DALLAS
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State | TX
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Zip | 75261-0344
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Country | US
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Telephone | 254-245-9175
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Fax | 254-213-7771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | H1967
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License Number State | TX
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