Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 6566 | AL |
NPI | 1013018977 |
---|---|
Provider Name | Dr. John P Hagler |
First Address | Montgomery, AL 36124-2927 |
Second Address | Montgomery, AL 36117-7816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C70107 | (02) | |
C70107 | (02) | AL |