Individual
JON RICHARD VAN DER HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861
Mailing address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29424
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
817882800
—
MN
Enumeration date
03/09/2006
Last updated
01/15/2016
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