Individual
DAVID SHANE HAGEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1412 BLUE OAKS BLVD, ROSEVILLE, CA 95747-7143
(916) 784-7546
(916) 784-7548
Mailing address
1412 BLUE OAKS BLVD, ROSEVILLE, CA 95747-7143
(916) 784-7546
(916) 784-7548
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA147050
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPA147050
BLUE SHIELD
CA
05
—
OPA147050
—
CA
Enumeration date
11/09/2005
Last updated
03/15/2023
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