Provider Demographics
NPI:1093997181
Name:NAGLE, JACKSON CAMERON (DO)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:CAMERON
Last Name:NAGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2018 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5218
Mailing Address - Country:US
Mailing Address - Phone:831-706-2220
Mailing Address - Fax:831-435-2034
Practice Address - Street 1:2018 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5218
Practice Address - Country:US
Practice Address - Phone:831-706-2220
Practice Address - Fax:831-435-2034
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine