Provider Demographics
NPI:1386917789
Name:HAGE, JEAN ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ERNEST
Last Name:HAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-1448
Mailing Address - Fax:239-343-1449
Practice Address - Street 1:13340 METRO PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4703
Practice Address - Country:US
Practice Address - Phone:239-343-1448
Practice Address - Fax:239-343-4178
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40042207RI0200X
AZ51641207RI0200X
FLME130802207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019922400Medicaid
IA1386917789Medicaid
AZ131386Medicaid
AZZ187506Medicare PIN
AZ131386Medicaid
IAI10610008Medicare PIN