Provider Demographics
NPI:1437738879
Name:HAGAMAN, ALEX (DO)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:HAGAMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2941
Mailing Address - Country:US
Mailing Address - Phone:870-492-5995
Mailing Address - Fax:870-508-8900
Practice Address - Street 1:250 DRILLERS RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5186
Practice Address - Country:US
Practice Address - Phone:870-492-5995
Practice Address - Fax:870-508-8900
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE17832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR326008003Medicaid