Provider Demographics
NPI:1144391665
Name:JACKSON, BARBARA BAGLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:BAGLEY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:763-427-0322
Practice Address - Fax:651-431-7505
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2018-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN343992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83254Medicare UPIN