DR. ROBERT JOHN HAGENBERG III (NPI# 1841679669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841679669 |
| Entity Type | Individual |
| Full Name | DR. ROBERT JOHN HAGENBERG III |
| Credential | M.D. |
| Practice Address |
3080 E Gentry Way Ste 210 Meridian ID 83642 |
| Mailing Address |
1501 N Campbell Ave Tucson AZ 85724-0001 |
| Practice Telephone | 2088102309 |
| Mailing Telephone | 5206267233 |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2018-06-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
R75074 | AZ | Allopathic & Osteopathic Physicians |
| Street Address |
3080 E GENTRY WAY STE 210 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497797302 | Ann C Agnew | Internal Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642-3013 | 2006-06-12 |
| 1376167114 | Amy Michele Zappia | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642-3013 | 2020-06-06 |
| 1780038711 | Alexander William Loehr | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642-3013 | 2016-04-15 |
| 1477916310 | Tara Kenny | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642-3013 | 2016-03-29 |
| 1619363520 | Adam Smith | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642-3013 | 2015-04-08 |
| 1962842815 | Carly Anne Cox | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642 | 2013-06-25 |
| 1477748507 | Trevor Grubbs | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642-3013 | 2007-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346286598 | Walter Lewis Willis | Emergency Medicine | 1314 19th Ave, Meridian, MS 39301-4116 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538516471 | Anthony Christopher Derrico | Emergency Medicine | 366 Gunfighter Ave Ste 498, Mountain Home Afb, ID 83648-5258 | 2016-05-20 |
| 1881752913 | Richard K Thurston | Emergency Medicine | 229 S 7th Street, St Maries, ID 83861 | 2006-12-04 |
| 1255399820 | Warren William Gude | Emergency Medicine | 600 Robbins Road, The Center for Wound Healing and Hyperbaric Medicine, Boise, ID 83702 | 2006-05-03 |
| 1821529918 | Jonathan Subaitani | Emergency Medicine | 11197 W Fairview Ave, Boise, ID 83713 | 2017-03-21 |
| 1194019406 | Michael Anderson | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2011-06-03 |
| 1508003104 | Rocky Mountain Emergency Physicians, LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201 | 2009-01-19 |
| 1225201148 | Rodney Gillman Jay Jr. | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2008-04-11 |
| 1720114275 | North Idaho Immediate Care | Emergency Medicine | 750 N Syringa St, Suite 100, Post Falls, ID 83854-5275 | 2007-02-26 |
| 1407903669 | Debra K Mckinnon | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| 1710034988 | Kurt R Martyn | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.