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NPI Code Detail

MEDICARE: DR. JACKSON CAMERON NAGLE DO

MEDICARE:  DR. JACKSON CAMERON NAGLE  DO
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
1207Q00000XFamily Medicine Physician20A11275CA

General Provider Information

NPI Number : 1093997181
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACKSON CAMERON NAGLE DO
Provider Business Mailing Address
First Line : 2018 MISSION ST
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-5218
Country : US
Telephone Number : 831-706-2220
Fax Number : 831-435-2034
Provider Business Practice Location Address
First Line : 2018 MISSION ST
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-5218
Country : US
Telephone Number : 831-706-2220
Fax Number : 831-435-2034
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2007
Last Update Date : 01/24/2014

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Directions to “ DR. JACKSON CAMERON NAGLE DO” Practice Location

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