Provider Demographics
NPI:1083775134
Name:JOHN P HAGLER MD LLC
Entity Type:Organization
Organization Name:JOHN P HAGLER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAGLER MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-649-2091
Mailing Address - Street 1:PO BOX 242927
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2927
Mailing Address - Country:US
Mailing Address - Phone:334-649-2091
Mailing Address - Fax:334-649-2097
Practice Address - Street 1:7051 FAIN PARK DR
Practice Address - Street 2:STE 114
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7816
Practice Address - Country:US
Practice Address - Phone:334-649-2091
Practice Address - Fax:334-649-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
AL6566208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529919310Medicaid
ALJ849Medicare PIN