Provider Demographics
NPI:1710923156
Name:HAGAN, LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 NW HIGHWAY 225
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-1859
Mailing Address - Country:US
Mailing Address - Phone:352-351-2280
Mailing Address - Fax:352-351-3909
Practice Address - Street 1:1541 SW 1ST AVE
Practice Address - Street 2:SUTIE 105
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6532
Practice Address - Country:US
Practice Address - Phone:352-622-8152
Practice Address - Fax:352-622-4408
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14334208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79545OtherBCBS
FLD58838Medicare UPIN
FLAR210ZMedicare PIN