| Doctor Name: | DR. GEORGE H HAGEN |
| NPI Number: | 1114019056 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | O.D. |
| License Number: | |
| Business Practice Address: | 1114 E Main St Trinidad, CO - 810822034 |
| Business Phone Number: | 7198467342 |
| Business Fax Number: | 7198464041 |
| Mailing Address: | 1114 E Main St, TRINIDAD |
| State: | CO |
| Postal Code: | 810822034 |
| Phone Number: | 7198467342 |
| Fax Number: | 7198464041 |
| NPI Enumeration Date: | 09/29/2006 |
| NPI Last Update Date: | 05/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |