Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5000775015 | WI |
NPI | 1104997477 |
---|---|
Provider Name | Ronald Charles Hager |
First Address | Rice Lake, WI 54868-5001 |
Second Address | Rice Lake, WI 54868-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 22/03/2011 |