| Doctor Name: | DR. JASON P HAGEN |
| NPI Number: | 1093008401 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 205679 |
| Business Practice Address: | 403 W 8th St Deridder, LA - 706345507 |
| Business Phone Number: | 3374638977 |
| Business Fax Number: | 3374623093 |
| Mailing Address: | 403 W 8th St, DERIDDER |
| State: | LA |
| Postal Code: | 706345507 |
| Phone Number: | 3374638977 |
| Fax Number: | 3374623093 |
| NPI Enumeration Date: | 05/17/2011 |
| NPI Last Update Date: | 03/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 205679 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |