Provider Demographics
NPI:1609914407
Name:HAGERTY, R DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:R DANIEL
Middle Name:
Last Name:HAGERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W 6TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2540
Mailing Address - Country:US
Mailing Address - Phone:509-904-9000
Mailing Address - Fax:509-703-7799
Practice Address - Street 1:307 W 6TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2540
Practice Address - Country:US
Practice Address - Phone:509-904-9000
Practice Address - Fax:509-703-7799
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60013894207P00000X
WAMD60013894208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8511610Medicaid
WA8511610Medicaid
WAI73926Medicare UPIN