Provider Demographics
NPI:1841361938
Name:JAEGER, DOMINIC ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:ARTHUR
Last Name:JAEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CROSSGATES BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2601
Mailing Address - Country:US
Mailing Address - Phone:601-644-1361
Mailing Address - Fax:
Practice Address - Street 1:350 CROSSGATES BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2601
Practice Address - Country:US
Practice Address - Phone:601-664-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03281556Medicaid
MSP01184541OtherRR MEDICARE
MS03281556Medicaid
MSF65332Medicare UPIN
MS279163YJ5DMedicare PIN
MSP01184541OtherRR MEDICARE