Individual
DR. JEFFREY LARS HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5400 W HILLSDALE AVE, VISALIA, CA 93291-8222
(559) 738-7500
(559) 734-2055
Mailing address
5400 W HILLSDALE AVE, VISALIA, CA 93291-8222
(559) 738-7500
(559) 734-2055
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E4634
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
E4634
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
PO807
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366570772
GROUP NPI
CA
05
—
1366570772
—
CA
Enumeration date
12/23/2005
Last updated
10/03/2016
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