MEDICARE: JACK DROGT 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
1	207X00000X	Orthopaedic Surgery Physician	28922	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200023910	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932177060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK DROGT MD

Provider Business Mailing Address
First Line	:	710 COMMERCE DR STE 200
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-4925
Country	:	US
Telephone Number	:	651-968-5042
Fax Number	:	651-968-5904

Provider Business Practice Location Address
First Line	:	2090 WOODWINDS DR
Second Line	:	SUITE 101
City	:	WOODBURY
State	:	MN
Zip	:	55125-2522
Country	:	US
Telephone Number	:	651-968-5801
Fax Number	:	651-968-5899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/01/2015

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