Provider Demographics
NPI:1619131422
Name:HAGAN, EUGENE A (DO)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:HAGAN
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 1:701 HATHAWAY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3549
Mailing Address - Country:US
Mailing Address - Phone:937-294-7752
Mailing Address - Fax:
Practice Address - Street 1:701 HATHAWAY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-3549
Practice Address - Country:US
Practice Address - Phone:937-294-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 . 001787208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery