Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07000289A | IN |
Y | 222Z00000X | Podiatrist | 07000289A | IN |
NPI | 1063478212 |
---|---|
Provider Name | Dr. Anthony D. Jagger |
First Address | Franklin, IN 46131-2795 |
Second Address | Franklin, IN 46131-2795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 17/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100111340 | (05) | IN |