Individual
DR. TYSON PETER HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
280 EXEMPLA CIR, LAFAYETTE, CO 80026-3370
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
36826
IA
207RR0500X
Rheumatology Physician
36826
IA
207RR0500X
Rheumatology Physician
Primary
50296
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022077
KAISER COMMERCIAL NUMBER
CO
05
—
0740456
—
IA
01
—
26721
WELLMARK BCBS
IA
05
—
95239758
—
CO
Enumeration date
09/01/2006
Last updated
06/18/2021
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