MEDICARE: JEFF E. HAGEN, M.D.

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	207V00000X	Obstetrics & Gynecology Physician	G3424	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00FN79	OTHER		BLUE CROSS PROVIDER NUMBE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598899304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF E. HAGEN, M.D.

Provider Business Mailing Address
First Line	:	301 HIGHWAY 71 W
Second Line	:	SUITE 111
City	:	BASTROP
State	:	TX
Zip	:	78602-4105
Country	:	US
Telephone Number	:	512-304-0318
Fax Number	:	512-308-9649

Provider Business Practice Location Address
First Line	:	2410 E RIVERSIDE DR
Second Line	:	SUITE G-2
City	:	AUSTIN
State	:	TX
Zip	:	78741-3083
Country	:	US
Telephone Number	:	512-445-4800
Fax Number	:	512-308-9649

Authorized Official
Title or Position	:	SOLE PROPIETOR
Name	:	JEFF HAGEN
Credential	:	M.D.
Telephone Number	:	512-304-0318

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	02/20/2013

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