Provider Demographics
NPI:1063599553
Name:JAMES M HAGEMAN MD PA
Entity type:Organization
Organization Name:JAMES M HAGEMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-452-0109
Mailing Address - Street 1:3724 JEFFERSON ST STE 111
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6219
Mailing Address - Country:US
Mailing Address - Phone:512-452-0109
Mailing Address - Fax:512-452-2706
Practice Address - Street 1:3724 JEFFERSON ST STE 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6219
Practice Address - Country:US
Practice Address - Phone:512-452-0109
Practice Address - Fax:512-452-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management