Provider Demographics
NPI:1821427816
Name:DIANA HAGER M.D.
Entity Type:Organization
Organization Name:DIANA HAGER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-485-8100
Mailing Address - Street 1:PO BOX 1730
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-1730
Mailing Address - Country:US
Mailing Address - Phone:405-485-8100
Mailing Address - Fax:405-485-8104
Practice Address - Street 1:1301 N COUNCIL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8041
Practice Address - Country:US
Practice Address - Phone:405-485-8100
Practice Address - Fax:405-485-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG06622Medicare UPIN