Individual
JEDD A HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
311 S CLARK ST, CARROLL, IA 51401-3038
(712) 792-8257
(712) 792-8234
Mailing address
311 S CLARK ST, CARROLL, IA 51401-3038
(712) 794-5257
(712) 794-5234
Taxonomy
Speciality
Code
Description
License number
State
207ZM0300X
Medical Microbiology Physician
Primary
30259
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119636
—
IA
01
—
50190
BCBS
IA
Enumeration date
08/23/2006
Last updated
09/10/2021
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