MEDICARE: KENNETH J HAGER 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	2085R0202X	Diagnostic Radiology Physician	000022796	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	511-52186	OTHER	AL	BLUE CROSS
3	P01409686	OTHER	AL	RRMC

General Provider Information

NPI Number	:	1477538163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH J HAGER MD

Provider Business Mailing Address
First Line	:	2000A SOUTHBRIDGE PKWY
Second Line	:	STE 300
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-7718
Country	:	US
Telephone Number	:	205-871-4274
Fax Number	:	205-871-4301

Provider Business Practice Location Address
First Line	:	3400 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8950
Country	:	US
Telephone Number	:	205-221-3523
Fax Number	:	205-221-3560

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	12/30/2015

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