Provider Demographics
NPI:1538039375
Name:BUGG, JACKSON COOPER (BLS)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:COOPER
Last Name:BUGG
Suffix:
Gender:M
Credentials:BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23603 OLD DAY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-7792
Mailing Address - Country:US
Mailing Address - Phone:564-900-4511
Mailing Address - Fax:
Practice Address - Street 1:23603 OLD DAY CREEK RD
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-7792
Practice Address - Country:US
Practice Address - Phone:564-900-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAB78FCB207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services