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Individual

DR. JONATHAN TAYLOR HAGEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
212 ELKS POINT RD STE 200, ZEPHYR COVE, NV 89448-8001
(775) 589-8950
(775) 588-1299
Mailing address
1111 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6207
(530) 543-5659
(530) 541-8723

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
17021
NV
207X00000X
Orthopaedic Surgery Physician
A148997
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200445860A
OK
Enumeration date
05/30/2012
Last updated
07/21/2022
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