Individual
GARRY L HAGSTROM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 BINZ ST, 1180, HOUSTON, TX 77004-6900
(713) 520-6790
Mailing address
4224 TENNYSON ST, HOUSTON, TX 77005-2752
(713) 667-6124
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10014996
—
TX
01
—
81C091
BLUE CROSS BLUE SHEILD
TX
Enumeration date
03/29/2006
Last updated
07/09/2007
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