Provider Demographics
NPI:1023122256
Name:HAGER, DIANA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:HAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-7915
Mailing Address - Country:US
Mailing Address - Phone:405-282-9333
Mailing Address - Fax:405-282-9598
Practice Address - Street 1:3106 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-8712
Practice Address - Country:US
Practice Address - Phone:405-282-9333
Practice Address - Fax:405-282-9598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18136207V00000X, 208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G0622Medicare UPIN