Provider Demographics
NPI:1881893436
Name:PAUL GUY HAGOOD
Entity type:Organization
Organization Name:PAUL GUY HAGOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:HAGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-765-1969
Mailing Address - Street 1:1908 N. 14TH ST.
Mailing Address - Street 2:201
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2039
Mailing Address - Country:US
Mailing Address - Phone:580-765-1969
Mailing Address - Fax:580-765-9344
Practice Address - Street 1:1908 N 14TH ST
Practice Address - Street 2:201
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2014
Practice Address - Country:US
Practice Address - Phone:580-765-1969
Practice Address - Fax:580-765-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18856208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200522040Medicare PIN