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Individual

DR. JACK DONALDSON HAGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1600 SW ARCHER ROAD PO BOX 117500 RM D2-49, GAINESVILLE, FL 32610-6122
(352) 273-6575
Mailing address
1 PINCKNEY BLVD, BEAUFORT, SC 29902-6122
(843) 228-5536

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
55070
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
014759500
FL
Enumeration date
06/27/2006
Last updated
09/08/2020
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