Provider Demographics
NPI:1487881165
Name:JAKOB JAGGY, MD, INC
Entity type:Organization
Organization Name:JAKOB JAGGY, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKOB
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGGY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-588-8900
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CA
Mailing Address - Zip Code:95310-0329
Mailing Address - Country:US
Mailing Address - Phone:209-588-8900
Mailing Address - Fax:209-588-9995
Practice Address - Street 1:22603 PARROTTS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CA
Practice Address - Zip Code:95310-9726
Practice Address - Country:US
Practice Address - Phone:209-588-8900
Practice Address - Fax:209-588-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A66760Medicare PIN
CA9732032Medicare UPIN