Provider Demographics
NPI:1497738090
Name:HAGLE, SCOTT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:HAGLE
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 1:420 W MAGNETIC ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2700
Mailing Address - Country:US
Mailing Address - Phone:906-225-4821
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:420 W MAGNETIC ST
Practice Address - Street 2:SUITE ER
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2711
Practice Address - Country:US
Practice Address - Phone:888-674-0854
Practice Address - Fax:906-225-3370
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082043207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301082043OtherMICHIGAN LICENSE NUMBER
MI4541822Medicaid
MI4541822Medicaid
MI0M36120012Medicare PIN