Individual
DR. JASON P HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 WALTERS ST, LAKE CHARLES, LA 70607-4647
(337) 480-8066
(337) 480-8061
Mailing address
PO BOX 122108 DEPT 2108, DALLAS, TX 75312-0001
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD205679
LA
261QP2300X
Primary Care Clinic/Center
205679
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2150383
—
LA
01
—
MD.205679
STATE LICENSE
LA
Enumeration date
05/17/2011
Last updated
04/27/2022
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