Provider Demographics
NPI:1689899098
Name:LAGEN, THOMAS HARDY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HARDY
Last Name:LAGEN
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:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3815
Mailing Address - Country:US
Mailing Address - Phone:253-363-6246
Mailing Address - Fax:253-514-6829
Practice Address - Street 1:1310 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1907
Practice Address - Country:US
Practice Address - Phone:253-363-6246
Practice Address - Fax:253-514-6829
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040243208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice