Provider Demographics
NPI:1912205766
Name:MATS F. HAGSTROM, MD, INC.
Entity Type:Organization
Organization Name:MATS F. HAGSTROM, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATS
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-885-4343
Mailing Address - Street 1:909 HYDE ST
Mailing Address - Street 2:STE 423
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4845
Mailing Address - Country:US
Mailing Address - Phone:415-885-4343
Mailing Address - Fax:415-885-4267
Practice Address - Street 1:909 HYDE ST
Practice Address - Street 2:STE 423
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4845
Practice Address - Country:US
Practice Address - Phone:415-885-4343
Practice Address - Fax:415-885-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80721208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty