Provider Demographics
NPI:1043206683
Name:HAGEN, BARBARA J (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:J
Other - Last Name:KEMPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:413 ALLUMBAUGH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9219
Mailing Address - Country:US
Mailing Address - Phone:208-323-1125
Mailing Address - Fax:208-323-9604
Practice Address - Street 1:413 ALLUMBAUGH ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9219
Practice Address - Country:US
Practice Address - Phone:208-323-1125
Practice Address - Fax:208-323-9604
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM94102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G88102Medicare UPIN