Healthcare Provider Details

I. General information

NPI: 1861654527
Provider Name (Legal Business Name): RYAN ROBERT JAGGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

IV. Provider business mailing address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

V. Phone/Fax

Practice location:
  • Phone: 800-622-6575
  • Fax: 765-284-4266
Mailing address:
  • Phone: 800-622-6575
  • Fax: 765-284-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11014483A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: