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Individual
DEREK A HAGEN
Active
Individual
DEREK A HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3954
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3954
LICENSE
AK
05
—
MD39541
—
AK
Enumeration date
04/19/2006
Last updated
03/07/2023
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