MEDICARE: DR. JOHN CHARLES HAGAN III 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	207W00000X	Ophthalmology Physician	R6034	MO

General Provider Information

NPI Number	:	1922091297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES HAGAN III MD

Provider Business Mailing Address
First Line	:	4801 S CLIFF AVE
Second Line	:	SUITE 100
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-7015
Country	:	US
Telephone Number	:	816-478-1230
Fax Number	:	816-478-4413

Provider Business Practice Location Address
First Line	:	9401 N OAK TRFY
Second Line	:	STE 200
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2233
Country	:	US
Telephone Number	:	816-478-1230
Fax Number	:	816-350-6801

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	12/06/2007

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