Provider Demographics
NPI:1891200143
Name:HAGEMAN, THOMAS (RVT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HAGEMAN
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20395 W MONARCH CT
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7650
Mailing Address - Country:US
Mailing Address - Phone:602-614-5253
Mailing Address - Fax:
Practice Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4799
Practice Address - Country:US
Practice Address - Phone:623-760-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1527972085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound