Provider Demographics
NPI:1588773675
Name:HAGAMAN, FRANCES EDNA (MD)
Entity type:Individual
Prefix:
First Name:FRANCES
Middle Name:EDNA
Last Name:HAGAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:748 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1814
Mailing Address - Country:US
Mailing Address - Phone:318-861-2354
Mailing Address - Fax:
Practice Address - Street 1:2924 KNIGHT ST
Practice Address - Street 2:BUILDING 3 SUITE 350
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2415
Practice Address - Country:US
Practice Address - Phone:318-862-3053
Practice Address - Fax:318-862-3080
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA0094292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA133140Medicaid
LA133140Medicaid
5K853F600Medicare ID - Type Unspecified