Provider Demographics
NPI:1760532006
Name:HAGBERG, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:HAGBERG
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 874388
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4388
Mailing Address - Country:US
Mailing Address - Phone:907-376-9893
Mailing Address - Fax:
Practice Address - Street 1:MAT SU EMPERCENCY MEDICINE PHYSICIANS AT MSRMC
Practice Address - Street 2:2500 S. WOODWORTH LOOP
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-746-7511
Practice Address - Fax:907-746-7533
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5438207P00000X
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8938154Medicaid
NC38154OtherBCBS
NC38154OtherBCBS
NC8938154Medicaid