Provider Demographics
NPI:1992732317
Name:KEENE, JAGGERS C (MD)
Entity type:Individual
Prefix:DR
First Name:JAGGERS
Middle Name:C
Last Name:KEENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:890 MISSOURI AVE N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1802
Mailing Address - Country:US
Mailing Address - Phone:727-739-8200
Mailing Address - Fax:727-739-8204
Practice Address - Street 1:890 MISSOURI AVE N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1802
Practice Address - Country:US
Practice Address - Phone:727-739-8200
Practice Address - Fax:727-739-8204
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79089Medicare UPIN
57839ZMedicare ID - Type Unspecified