MEDICARE: JAKOB JAGGY, MD, INC

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
1	207Q00000X	Family Medicine Physician	A66760	CA

General Provider Information

NPI Number	:	1487881165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAKOB JAGGY, MD, INC

Provider Business Mailing Address
First Line	:	PO BOX 329
Second Line	:
City	:	COLUMBIA
State	:	CA
Zip	:	95310-0329
Country	:	US
Telephone Number	:	209-588-8900
Fax Number	:	209-588-9995

Provider Business Practice Location Address
First Line	:	22603 PARROTTS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	CA
Zip	:	95310-9726
Country	:	US
Telephone Number	:	209-588-8900
Fax Number	:	209-588-9995

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAKOB JAGGY
Credential	:	MD
Telephone Number	:	209-588-8900

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	06/19/2009

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