Provider Demographics
NPI:1134200629
Name:HAGELE, JOHN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:HAGELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 SIERRA COLLEGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5089
Mailing Address - Country:US
Mailing Address - Phone:530-272-3411
Mailing Address - Fax:530-272-3474
Practice Address - Street 1:400 SIERRA COLLEGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5089
Practice Address - Country:US
Practice Address - Phone:530-272-3411
Practice Address - Fax:530-272-3474
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG81026207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG810260Medicaid
CAGR0004680Medicaid
CAG810260Medicaid
CAG46855Medicare UPIN