Provider Demographics
NPI:1598899304
Name:JEFF E. HAGEN, M.D.
Entity Type:Organization
Organization Name:JEFF E. HAGEN, M.D.
Other - Org Name:AUSTIN OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-304-0318
Mailing Address - Street 1:301 HIGHWAY 71 W
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4105
Mailing Address - Country:US
Mailing Address - Phone:512-304-0318
Mailing Address - Fax:512-308-9649
Practice Address - Street 1:2410 E RIVERSIDE DR
Practice Address - Street 2:SUITE G-2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3083
Practice Address - Country:US
Practice Address - Phone:512-445-4800
Practice Address - Fax:512-308-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3424207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00FN79OtherBLUE CROSS PROVIDER NUMBE
TX041869104Medicaid
00FN79OtherBLUE CROSS PROVIDER NUMBE
610342Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER