Provider Demographics
NPI:1508842006
Name:HAGER, BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:HAGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 EMERALD BAY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6817
Mailing Address - Country:US
Mailing Address - Phone:702-686-9347
Mailing Address - Fax:888-340-2427
Practice Address - Street 1:3725 EMERALD BAY CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6817
Practice Address - Country:US
Practice Address - Phone:702-686-9347
Practice Address - Fax:888-340-2427
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1233207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507043Medicaid
NVF78807Medicare UPIN
F78807Medicare UPIN
NV101170Medicare ID - Type Unspecified