Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 18136 | OK |
Y | 208D00000X | General Practice Physician | 18136 | OK |
NPI | 1023122256 |
---|---|
Provider Name | Dr. Diana Lynn Hager |
First Address | Shawnee, OK 74804-2135 |
Second Address | Choctaw, OK 73020-9761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 31/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G0622 | (02) |