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General NPI Number Information
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NPI Number | 1902850779
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Entity Type | Individual
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Provider Name | REGG A HAGGE MD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 711 ONYX ST
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City | KEMMERER
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State | WY
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Zip | 83101-3214
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Country | US
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Telephone | 307-877-4496
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Fax | 307-877-9769
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Provider Business Mailing Address
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Address Line | 711 ONYX ST
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City | KEMMERER
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State | WY
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Zip | 83101-3214
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Country | US
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Telephone | 307-877-4496
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Fax | 307-877-9769
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11278A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5642
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License Number State | SD
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