MEDICARE: LINDA M HAGGARD PAC

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	363A00000X	Physician Assistant	3341	AZ
2	363AM0700X	Medical Physician Assistant	3341	AZ

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

General Provider Information

NPI Number	:	1871508655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA M HAGGARD PAC

Provider Business Mailing Address
First Line	:	1146 WEST SOUTH ROUTE 89A
Second Line	:	SUITE B1
City	:	SEDONA
State	:	AZ
Zip	:	86336-5768
Country	:	US
Telephone Number	:	928-284-0166
Fax Number	:	928-284-1810

Provider Business Practice Location Address
First Line	:	450 S WILLARD ST STE 101
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-6744
Country	:	US
Telephone Number	:	928-284-0166
Fax Number	:	928-284-1810

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/18/2022

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Directions to “ LINDA M HAGGARD PAC” Practice Location

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