Kerry Brent Hagen, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD18505 Issued in OR

Practice address

1955 NW Northrup St
Portland, OR 97209-1614

Phone

(503) 227-2020

Fax

(503) 222-0614

NPI assigned

Nov 15, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1295717379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11086 SE OAK ST",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226692",
            "telephone_number": "503-557-2020",
            "fax_number": "503-344-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1955 NW NORTHRUP ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091614",
            "telephone_number": "503-227-2020",
            "fax_number": "503-222-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "KERRY",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD18505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121033",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Marina Hagen, PA-C
• Jennie B Hagen, MA
• Katherine Lindsey Hagen, LMT
• Kathryn S Hagen, M.D.
• Kathy I Hagen, MS, MFT
• Logan Hagen
• Paul Wendell Hagen, DC
• Cooper David Hager
• Corri Lynn Hager, L.M.F.T.I.
• Erika Regan Hager

• Ophthalmology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Ophthalmology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.