Van Der Hagen, Jon Richard

Van Der Hagen, Jon Richard is an individual health care provider with primary practice located at 523 N 3Rd St , Brainerd MN 56401-3054. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Van Der Hagen, Jon Richard can be contacted via phone (218) 829-2861.

Contact Information

Primary practice address
523 N 3Rd St Brainerd MN 56401-3054
Phone: (218) 829-2861
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 29424 Minnesota

Profile Details

NPI number 1326016171
LBN Legal business name Van Der Hagen, Jon Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 9th, 2006
Last updated Jan 15th, 2016 - about 8 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 1326016171 NPPES
Minnesota MEDICAID 817882800

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