Provider Demographics
NPI:1356945380
Name:GAGER, JARED MICHAEL
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:GAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14083 STEFFENSEN ST
Mailing Address - Street 2:
Mailing Address - City:GOWEN
Mailing Address - State:MI
Mailing Address - Zip Code:49326-9502
Mailing Address - Country:US
Mailing Address - Phone:616-302-0857
Mailing Address - Fax:
Practice Address - Street 1:1300 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4732
Practice Address - Country:US
Practice Address - Phone:989-401-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other