Provider Demographics
NPI:1568449668
Name:HAGER, DENVER H (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DENVER
Middle Name:H
Last Name:HAGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-9635
Mailing Address - Country:US
Mailing Address - Phone:719-332-3097
Mailing Address - Fax:
Practice Address - Street 1:88 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-9045
Practice Address - Country:US
Practice Address - Phone:719-419-8002
Practice Address - Fax:719-419-8003
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18424058Medicaid
COP23757Medicare UPIN
CO402118Medicare ID - Type Unspecified