Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 22558 | WV |
NPI | 1053350751 |
---|---|
Provider Name | Dr. Larry Lynn Hagan |
First Address | Huntington, WV 25703-2019 |
Second Address | Huntington, WV 25703-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 27/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011693000 | (05) | WV |
3810007713 | (05) | WV |
I68547 | (02) | WV |
L2725779 | (05) | OH |