| Doctor Name: | DENNIS KEITH HAGAN |
| NPI Number: | 1144277468 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | COBBLER |
| License Number: | |
| Business Practice Address: | 1240 E John Rowan Blvd Bardstown, KY - 400042066 |
| Business Phone Number: | 5023497119 |
| Business Fax Number: | |
| Mailing Address: | 1240 E John Rowan Blvd, BARDSTOWN |
| State: | KY |
| Postal Code: | 400042066 |
| Phone Number: | 5023497119 |
| Fax Number: | |
| NPI Enumeration Date: | 05/30/2006 |
| NPI Last Update Date: | 01/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |