Provider Demographics
NPI:1376048561
Name:HAGMAN, DALLAS SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:SAMUEL
Last Name:HAGMAN
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:ORTHOPAEDIC SURGERY ACADEMIC OFFICE, ATTN: MONICA WELSH
Mailing Address - Street 2:550 S. JACKSON STREET, ACB, 1ST FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40292
Mailing Address - Country:US
Mailing Address - Phone:502-852-6902
Mailing Address - Fax:
Practice Address - Street 1:ORTHOPAEDIC SURGERY ACADEMIC OFFICE, ATTN: MONICA WELSH
Practice Address - Street 2:550 S. JACKSON STREET, ACB, 1ST FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292
Practice Address - Country:US
Practice Address - Phone:502-852-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program