Provider Demographics
NPI:1164458105
Name:HAGAN, WARREN EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:EUGENE
Last Name:HAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 BROADWAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2819
Mailing Address - Country:US
Mailing Address - Phone:217-224-6423
Mailing Address - Fax:
Practice Address - Street 1:1132 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2819
Practice Address - Country:US
Practice Address - Phone:217-224-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6867208200000X, 207Y00000X
IL036141011208200000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1164458105Medicaid
MO701000041Medicare PIN
D53348Medicare UPIN
MOP00800173OtherRAILROAD MEDICARE
D53348Medicare UPIN