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General NPI Number Information
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NPI Number | 1851977490
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Entity Type | Individual
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Provider Name | MATHEW ADAM HAGEN
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 119 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5779
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Country | US
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Telephone | 813-681-5551
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Fax | 813-916-2944
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Provider Business Mailing Address
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Address Line | 4609 W HAWTHORNE RD
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City | TAMPA
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State | FL
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Zip | 33611-3120
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Country | US
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Telephone | 256-763-1413
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | OS21075
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License Number State | FL
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