Individual
MATTHEW HAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1855 MADISON AVE, IDAHO FALLS, ID 83404-1212
(208) 881-5351
Mailing address
PO BOX 3446, IDAHO FALLS, ID 83403-3446
(208) 552-8580
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036145857
IL
208600000X
Surgery Physician
Primary
M-15773
ID
208600000X
Surgery Physician
MT201381
PA
2086S0122X
Plastic and Reconstructive Surgery Physician
M-15773
ID
Other
Enumeration date
08/12/2012
Last updated
06/23/2021
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