MEDICARE: DR. ROBERT JAGGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146D00000X	Personal Emergency Response Attendant	G28548	CA

General Provider Information

NPI Number	:	1528127503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JAGGER MD

Provider Business Mailing Address
First Line	:	1076 CAROL LN APT 53
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4739
Country	:	US
Telephone Number	:	925-373-4144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1076 CAROL LN APT 53
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4739
Country	:	US
Telephone Number	:	925-373-4144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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