Provider Demographics
NPI:1699087163
Name:SHERIGAR, JAGANNATH M (MD)
Entity type:Individual
Prefix:DR
First Name:JAGANNATH
Middle Name:M
Last Name:SHERIGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5752
Practice Address - Street 1:789 EASTERN BYPASS
Practice Address - Street 2:MEDICAL OFFICE BUILDING # 1, SUITE 14
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-625-0900
Practice Address - Fax:859-625-0995
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS21666208M00000X
KY53065207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSFS2763173OtherDEA