Provider Demographics
NPI:1639149818
Name:HASEGAWA, ALAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:A
Last Name:HASEGAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPARTMENT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-491-5051
Mailing Address - Fax:918-502-5060
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-491-5051
Practice Address - Fax:918-502-5060
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK174092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
04501OtherCIGNA BEHAVIORAL HEALTH
4306562OtherAETNA BEHAVIORAL HEALTH
OK100216860CMedicaid
OK731308273-006OtherBLUE CROSS B SHIELD OF OK
OK100216860CMedicaid
4306562OtherAETNA BEHAVIORAL HEALTH