MEDICARE: JASON D HAGEMAN 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	207QS0010X	Sports Medicine (Family Medicine) Physician	35.098971	OH
2	207Q00000X	Family Medicine Physician	35.098971	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H336690	OTHER	OH	OH MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1851619936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON D HAGEMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 636930
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6930
Country	:	US
Telephone Number	:	513-981-5123
Fax Number	:	513-981-5015

Provider Business Practice Location Address
First Line	:	1800 E 5TH ST STE 1
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9180
Country	:	US
Telephone Number	:	419-692-5611
Fax Number	:	419-695-9401

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

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	12/15/2017

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Directions to “ JASON D HAGEMAN MD” Practice Location

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