Healthcare Provider Details

I. General information

NPI: 1497712087
Provider Name (Legal Business Name): JENNIFER BAGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVENUE
FORT LIBERTY NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRITT AVENUE
FORT LIBERTY NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8809
  • Fax:
Mailing address:
  • Phone: 910-907-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD-12050
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: