Individual
ANGELA RENE HAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7777 FOREST LANE, SUITE B332, DALLAS, TX 75230-6822
(972) 566-7788
(972) 566-8837
Mailing address
PO BOX 1810, SKYLAND, NC 28776-1810
(828) 575-2644
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03936
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190057301
—
TX
01
—
408468ZM3J
MEDICARE PTAN
TX
01
—
408468ZM3L
MEDICARE PTAN
TX
01
—
TXB114330
MEDICARE PTAN
TX
Enumeration date
10/22/2007
Last updated
11/17/2015
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