Healthcare Provider Details

I. General information

NPI: 1295710283
Provider Name (Legal Business Name): JODY LYNN DAGGETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 S HOSPITAL DR STE 103
GLOBE AZ
85501-9449
US

IV. Provider business mailing address

5880 S HOSPITAL DR STE 103
GLOBE AZ
85501-9447
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3193
  • Fax:
Mailing address:
  • Phone: 928-425-3261
  • Fax: 928-425-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11804
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: