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NPI Code Detail

MEDICARE: JAGJIT MANGAT MD

MEDICARE: JAGJIT MANGAT MD
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
1207P00000XEmergency Medicine Physician2002-0206NM
2207Q00000XFamily Medicine PhysicianMD60249786WA

General Provider Information

NPI Number : 1679516918
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAGJIT MANGAT MD
Provider Business Mailing Address
First Line : PO BOX 17130
Second Line :
City : RENO
State : NV
Zip : 89511-3103
Country : US
Telephone Number : 480-620-7181
Fax Number :
Provider Business Practice Location Address
First Line : 1221 HIGHLAND AVE
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2829
Country : US
Telephone Number : 509-758-5511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 05/23/2013

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