Individual
JOHN A HAGGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
20553
NE
2085R0202X
Diagnostic Radiology Physician
31859
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14706
LICENSE #
NE
05
—
2165159
—
IA
05
—
3165159
—
IA
01
—
31859
LICENSE #
IA
01
—
35328
BCBS
NE
01
—
40621
BCBS
IA
05
—
4165159
—
IA
05
—
5165159
—
IA
05
—
6165159
—
IA
01
—
821
MIDLANDS
—
01
—
BH4712851
CONTROLLED SUBSTANCE
IA
Enumeration date
06/20/2006
Last updated
03/07/2023
Update your record
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