Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 17911 | AL |
NPI | 1477507408 |
---|---|
Provider Name | Dr. Mark L Hagood |
First Address | Huntsville, AL 35801-6449 |
Second Address | Huntsville, AL 35801-6449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4460825 | AETNA (01) | AL |
F48369 | (02) | AL |