Hagman, Melissa Mae

Hagman, Melissa Mae is an individual health care provider with primary practice located at 500 W. Fort St # 111R, Boise ID 83702. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine. Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine is her primary health care specialty. Hagman, Melissa Mae can be contacted via phone (208) 422-1000.

Contact Information

Primary practice address
500 W. Fort St # 111R Boise ID 83702
Phone: (208) 422-1000
Fax: (208) 422-1319
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD00040136 Washington
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207RH0002X MD00040136 Washington
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207RH0002X M-11626 Idaho

Profile Details

NPI number 1649355447
LBN Legal business name Hagman, Melissa Mae
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 27th, 2006
Last updated Mar 11th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649355447 NPPES
Other 193980 INTERNAL ID-MOTOR VEHICLE ID
MEDICAID 8364945 INTERNAL ID-MOTOR VEHICLE ID

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