Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5489 | CO |
NPI | 1144288457 |
---|---|
Provider Name | Dr. Shan Daniel Hager |
First Address | Longmont, CO 80501-6056 |
Second Address | Longmont, CO 80501-6056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 20/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U98425 | (02) | CO |