Provider Demographics
NPI:1568531259
Name:HAGAR, JAMES MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:HAGAR
Suffix:
Gender:M
Credentials:PT
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 29
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-0029
Mailing Address - Country:US
Mailing Address - Phone:903-885-9906
Mailing Address - Fax:903-438-9636
Practice Address - Street 1:1129 INDUSTRIAL DR E
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-3326
Practice Address - Country:US
Practice Address - Phone:903-885-9906
Practice Address - Fax:903-438-9636
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1163353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4554OtherBCBS PROVIDER #
TX8G1472Medicare ID - Type UnspecifiedPROVIDER NUMBER