Individual
DR. MARK ALLEN HAGGENJOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
428 WEST VOTAW STREET, SUITE A, PORTLAND, IN 47371-0710
(260) 726-8822
(260) 726-7857
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02001027A
IN
207Q00000X
Family Medicine Physician
Primary
02001027A
IN
208M00000X
Hospitalist Physician
02001027A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100348680
—
IN
Enumeration date
05/02/2006
Last updated
01/08/2021
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