Healthcare Provider Details

I. General information

NPI: 1861702524
Provider Name (Legal Business Name): ERIC JAGGERS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 VISSING PARK ROAD
JEFFERSONVILLE IN
47130
US

IV. Provider business mailing address

3310 EAST 10TH ST #365
JEFFERSONVILLE IN
47130-7285
US

V. Phone/Fax

Practice location:
  • Phone: 812-258-1029
  • Fax:
Mailing address:
  • Phone: 812-258-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01045406A
License Number StateIN

VIII. Authorized Official

Name: DR. ERIC JAGGERS
Title or Position: MEMBER
Credential: M.D.
Phone: 812-258-1029