Individual
DR. MICHAEL WAYNE HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
620 E MONROE, MEXICO, MO 65265
(573) 582-4000
(573) 582-3712
Mailing address
8682 AUDRIAN COUNTRY RD, ROAD 353, MEXICO, MO 65265
(573) 581-4107
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36548
MO
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
36548
MO
208000000X
Pediatrics Physician
36548
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36548
STATE LICENSE
MO
Enumeration date
01/10/2006
Last updated
03/05/2020
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