Provider Demographics
NPI:1013913276
Name:HAGAN, DANIEL M (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:HAGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1404 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8202
Mailing Address - Country:US
Mailing Address - Phone:910-382-7424
Mailing Address - Fax:910-346-3303
Practice Address - Street 1:237 WHITE ST STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6351
Practice Address - Country:US
Practice Address - Phone:910-577-4977
Practice Address - Fax:910-577-4980
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2062083P0011X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908068Medicaid
NC8908068Medicaid
NC243111Medicare ID - Type Unspecified