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General NPI Number Information
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NPI Number | 1497057624
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Entity Type | Organization
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Legal Business Name | CECIL J HAGGERTY JR MD PC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 77 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1305
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Country | US
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Telephone | 585-637-3010
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Fax | 585-637-4919
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Provider Business Mailing Address
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Address Line | 77 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1305
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Country | US
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Telephone | 585-637-3010
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Fax | 585-637-4919
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Authorized Official
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Title or Position | PRESIDENT
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Name | CECIL J HAGGERTY JR.
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Credential | MD PC
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Telephone | 585-637-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 112867
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License Number State | NY
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