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NPI Code Detail

MEDICARE: DAVID KEITH HAGSTROM MD

MEDICARE: DAVID KEITH HAGSTROM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208VP0014XInterventional Pain Medicine PhysicianH1967TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1114307100OTHERFIRSTCARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154493997
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID KEITH HAGSTROM MD
Provider Business Mailing Address
First Line : PO BOX 610344
Second Line :
City : DALLAS
State : TX
Zip : 75261-0344
Country : US
Telephone Number : 254-245-9175
Fax Number : 254-213-7771
Provider Business Practice Location Address
First Line : 710 E 6TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-4655
Country : US
Telephone Number : 254-245-9175
Fax Number : 254-213-7771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 12/08/2025

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