Provider Demographics
NPI:1497785083
Name:HAGBERG, CARIN A (MD)
Entity Type:Individual
Prefix:
First Name:CARIN
Middle Name:A
Last Name:HAGBERG
Suffix:
Gender:F
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:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6200
Practice Address - Fax:713-500-6201
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6262207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129081901Medicaid
TX129081905Medicaid
TX81123GOtherBCBS
TX8X6104OtherBCBS
TX129081901Medicaid
TX8K5590Medicare PIN
TX81123GOtherBCBS
TX8X6104OtherBCBS