Individual
MELISSA MAE HAGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 W. FORT ST, # 111R, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST, # 111R, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00040136
WA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
M-11626
ID
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
MD00040136
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193980
INTERNAL ID-MOTOR VEHICLE ID
—
05
—
8364945
—
WA
Enumeration date
10/27/2006
Last updated
03/11/2022
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