1457525743 NPI number — DR. BRANDON ERNEST HAGLER DDS

Table of content: DR. BRANDON ERNEST HAGLER DDS (NPI 1457525743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457525743 NPI number — DR. BRANDON ERNEST HAGLER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGLER
Provider First Name:
BRANDON
Provider Middle Name:
ERNEST
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457525743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 CANAL ST APT 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-2673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-906-0099
Provider Business Mailing Address Fax Number:
504-309-6666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7023 READ LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70127-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-244-0177
Provider Business Practice Location Address Fax Number:
504-309-9666
Provider Enumeration Date:
04/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5929 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1859290 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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