Provider Demographics
NPI:1861467003
Name:HAGAN, MICHAEL PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILIP
Last Name:HAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1900 MEDI PARK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2187
Mailing Address - Country:US
Mailing Address - Phone:806-355-9447
Mailing Address - Fax:806-354-8662
Practice Address - Street 1:1301 S COULTER ST STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1764
Practice Address - Country:US
Practice Address - Phone:063-540-9508
Practice Address - Fax:806-356-1935
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010572202085R0001X, 2085R0203X
TXH89832085R0001X, 2085R0203X
FLME696792085R0203X
MA784852085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00473639OtherRR MEDICARE
VA830004532OtherRR MEDICARE
TXQ01000246OtherRR MEDICARE
VA5809487 541581185Medicaid
TX20685770Medicaid
VA920000080Medicare PIN
VA5809487 541581185Medicaid