Individual
ALAN KYLE HAGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1415 PANTHER LN, NAPLES, FL 34109-7874
(239) 404-3379
Mailing address
250 PARK SHORE DR APT 202, NAPLES, FL 34103-3440
(239) 404-3379
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
23903
AZ
2084P0800X
Psychiatry Physician
Primary
ME114651
FL
208VP0000X
Pain Medicine Physician
ME114651
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
436601
—
AZ
Enumeration date
01/23/2006
Last updated
07/21/2022
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