Jack Bragg
Gastroenterologist
101 S Fairview Road
Columbia
, Missouri 65201
Jack Bragg
Gastroenterologist
101 S Fairview Road
Columbia
, Missouri 65201
(573) 884-0943
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About
Features
Specialties
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Jack Bragg
- Po Box 843966
- Kansas City, MO
- Zip : 64184-3966
- Fax : (573) 884-0943
- Phone : (573) 884-3300
Second Address
- Jack Bragg
- 101 S Fairview Road
- Columbia, MO
- Zip : 65201
- Fax : (573) 884-8200
- Phone : (573) 884-7600
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RG0100X | Gastroenterologist | R5C31 | MO |
National Provider Identifier
| NPI | 1003865239 |
|---|---|
| Provider Name | Jack Bragg |
| First Address | Kansas City, MO 64184-3966 |
| Second Address | Columbia, MO 65201 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/05/2006 |
| Last Update Date | 18/04/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| E42717 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.