Provider Demographics
NPI:1790006708
Name:HAGEN, CONOR (MD)
Entity Type:Individual
Prefix:
First Name:CONOR
Middle Name:
Last Name:HAGEN
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 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:4100 EVERETT DR
Practice Address - Street 2:SUITE 400
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6146
Practice Address - Country:US
Practice Address - Phone:512-295-1333
Practice Address - Fax:512-295-1335
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL32790208000000X
TXP6973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322913001Medicaid
TX322913002Medicaid
TX322913002Medicaid
TX302137YKXYMedicare PIN