Provider Demographics
NPI:1588955231
Name:HAGAN, TYLER K (DPM)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:K
Last Name:HAGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612A MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5231
Mailing Address - Country:US
Mailing Address - Phone:252-633-3400
Mailing Address - Fax:252-633-9338
Practice Address - Street 1:612A MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5231
Practice Address - Country:US
Practice Address - Phone:252-633-3400
Practice Address - Fax:252-633-9338
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC617213EP1101X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457601601OtherGROUP NPI
NC1720489818Medicaid
NC1588955231OtherINDIVIDUAL NPI
NCNCK429B699Medicare PIN
NC6712460043Medicare NSC