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General NPI Number Information
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NPI Number | 1316232150
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Entity Type | Organization
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Legal Business Name | ROBERT WILLIAM HAGEN M.D., INC.
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 416 EAST COEUR D'ALENE AVENUE
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City | COEUR D'ALENE
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State | ID
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Zip | 83814
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Country | US
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Telephone | 208-667-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 416 EAST COEUR D'ALENE AVE.
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City | COEUR D'ALENE
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State | ID
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Zip | 83814
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Country | US
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Telephone | 208-667-1110
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Fax |
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Authorized Official
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Title or Position | VP
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Name | CHARLOTTE MARY HAGEN
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Credential |
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Telephone | 208-667-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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