MEDICARE: DR. JAMES S HAGOOD 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
1	2080P0214X	Pediatric Pulmonology Physician	C53950	CA
2	208000000X	Pediatrics Physician	C53950	CA

General Provider Information

NPI Number	:	1235126004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES S HAGOOD MD

Provider Business Mailing Address
First Line	:	3860 CALLE FORTUNADA
Second Line	:	STE #210
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4802
Country	:	US
Telephone Number	:	858-309-6303
Fax Number	:	858-309-6301

Provider Business Practice Location Address
First Line	:	8110 BIRMINGHAM WAY
Second Line	:	BLDG 28
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2758
Country	:	US
Telephone Number	:	858-966-5846
Fax Number	:	858-569-9052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	11/10/2011

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