Individual
MR. JAMES ROGER HAGERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1301 PLEASANT VALLEY RD, SUITE 202, OWENSBORO, KY 42303-9774
(270) 417-7500
(270) 417-7509
Mailing address
1301 PLEASANT VALLEY RD, SUITE 202, OWENSBORO, KY 42303-9774
(270) 417-7500
(270) 417-7509
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA453
KY
363AM0700X
Medical Physician Assistant
Primary
PA453
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000491613
ANTHEM
—
01
—
11621267
CAQH
KY
01
—
363AM0700X
TAXONOMY
KY
Enumeration date
06/09/2006
Last updated
11/21/2014
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