Provider Demographics
NPI:1376504738
Name:HAGER, NELSON A (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:A
Last Name:HAGER
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 1:1750 112TH AVE NE
Mailing Address - Street 2:SUITE D258
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3752
Mailing Address - Country:US
Mailing Address - Phone:425-451-2272
Mailing Address - Fax:425-451-1052
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-3752
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:425-451-1052
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042826208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation