Provider Demographics
NPI:1457367526
Name:HARGAN, PAUL W (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:HARGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-7200
Mailing Address - Fax:314-747-4189
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:DEPT RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6163
Practice Address - Country:US
Practice Address - Phone:314-362-7200
Practice Address - Fax:314-747-4189
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001623782085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205064801Medicaid
MOP00450108OtherRR MEDICARE GROUP DG5646
036012444OtherMO CARE
431725842MIDOtherMERCY
036012444OtherCARE
1390OtherMO BLUE
143150OtherBLUE CHOICE
MO39197012OtherBCBS OF KCMO
205064801OtherMO CAID
L83194OtherIL CARE
456993OtherH LINK
P00053295OtherRR CARE
1601681OtherPH PLAN
0360568092OtherIL CAID
300120232OtherRR CARE
46052OtherHCARE USA
MO39197012OtherBCBS OF KCMO
P00053295Medicare PIN
456993OtherH LINK
MOY02F726Medicare PIN