Provider Demographics
NPI:1063478212
Name:JAGGER, ANTHONY D (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:D
Last Name:JAGGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 W JEFFERSON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2795
Mailing Address - Country:US
Mailing Address - Phone:317-346-7722
Mailing Address - Fax:317-346-7725
Practice Address - Street 1:1159 W JEFFERSON ST STE 204
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2795
Practice Address - Country:US
Practice Address - Phone:317-346-7722
Practice Address - Fax:317-346-7725
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000289A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100111340Medicaid
IN210070001Medicare PIN