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General NPI Number Information
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NPI Number | 1821434499
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Entity Type | Organization
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Legal Business Name | JEFF E. HAGEN MD
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 301 HIGHWAY 71 W SUITE 111
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City | BASTROP
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State | TX
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Zip | 78602-4105
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Country | US
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Telephone | 521-304-0318
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Fax | 512-308-9649
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Provider Business Mailing Address
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Address Line | 301 HIGHWAY 71 W SUITE 111
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City | BASTROP
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State | TX
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Zip | 78602-4105
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Country | US
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Telephone | 521-304-0318
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Fax | 512-308-9649
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFF E HAGEN
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Credential | M.D.
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Telephone | 512-304-0318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | TX
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