Provider Demographics
NPI:1114116910
Name:JEFFREY J. HAGGENJOS, D.O., INC
Entity Type:Organization
Organization Name:JEFFREY J. HAGGENJOS, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:HAGGENJOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-344-4447
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-0231
Mailing Address - Country:US
Mailing Address - Phone:740-343-4447
Mailing Address - Fax:740-343-4451
Practice Address - Street 1:399 LINCOLN PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1078
Practice Address - Country:US
Practice Address - Phone:740-343-4447
Practice Address - Fax:740-343-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-002872208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJE934261Medicare PIN