Provider Demographics
NPI:1356054126
Name:HAGEN, JEFFREY BROOKS (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BROOKS
Last Name:HAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 N 161ST TER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-6423
Mailing Address - Country:US
Mailing Address - Phone:402-690-4357
Mailing Address - Fax:
Practice Address - Street 1:3331 N 161ST TER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6423
Practice Address - Country:US
Practice Address - Phone:402-690-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0962207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology