=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821427816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIANA HAGER M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2013
-----------------------------------------------------
Last Update Date | 11/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 N COUNCIL AVE SUITE B
-----------------------------------------------------
City | BLANCHARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73010-8041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-485-8100
-----------------------------------------------------
Fax | 405-485-8104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1730
-----------------------------------------------------
City | BLANCHARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73010-1730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-485-8100
-----------------------------------------------------
Fax | 405-485-8104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/PROVIDER
-----------------------------------------------------
Name | DR. DIANA LYNN HAGER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 405-485-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 18136
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------