Provider Demographics
NPI:1942248778
Name:JAEGER, BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JAEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-1678
Mailing Address - Country:US
Mailing Address - Phone:844-821-8137
Mailing Address - Fax:
Practice Address - Street 1:1600 PHILLIPS RD
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5304
Practice Address - Country:US
Practice Address - Phone:850-878-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD544872085R0203X, 2085U0001X
FLME1107742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004388300Medicaid
MDS187 / 0020OtherBLUECHOICE
FL14H59OtherBCBS OF FL
MDKDA7 / 697567-06OtherBC /BS OF MD
MD412400600Medicaid
G89386Medicare UPIN
FLFS689XMedicare PIN
FL14H59OtherBCBS OF FL