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Individual
JOHN HAGAN
Active
Individual
JOHN HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
R079848
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419031900
—
MD
01
—
960548-01 & 02
BLUE CROSS/BLUE SHIELD
MD
01
—
S062-0376
BLUE CROSS REGIONAL
MD
Enumeration date
07/17/2007
Last updated
05/28/2019
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