MEDICARE: DR. JOSHUA DENNIS HAGAN 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	2086S0102X	Surgical Critical Care Physician	ME115394	FL
2	2086S0127X	Trauma Surgery Physician	ME115394	FL
3	390200000X	Student in an Organized Health Care Education/Training Program
4	208600000X	Surgery Physician	ME115394	FL

General Provider Information

NPI Number	:	1952568602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA DENNIS HAGAN MD

Provider Business Mailing Address
First Line	:	2401 FRIST BLVD STE 5
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-241-6330
Fax Number	:	772-241-6331

Provider Business Practice Location Address
First Line	:	2401 FRIST BLVD STE 5
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-241-6330
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	07/15/2024

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