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General NPI Number Information
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NPI Number | 1275927576
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Entity Type | Individual
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Provider Name | JACOB RUSSELL HAGENBUCHER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1 S PARK ST
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City | MADISON
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State | WI
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Zip | 53715-1375
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Country | US
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Telephone | 608-287-2700
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Fax | 608-287-2722
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Provider Business Mailing Address
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Address Line | 7974 UW HEALTH CT
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City | MIDDLETON
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State | WI
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Zip | 53562-5531
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Country | US
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Telephone |
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP1188152
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1162
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License Number State | WI
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