Provider Demographics
NPI:1740692078
Name:JAEGER, JOEL (DO)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:JAEGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W BASSETT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8575
Mailing Address - Country:US
Mailing Address - Phone:317-421-3265
Mailing Address - Fax:
Practice Address - Street 1:275 W BASSETT RD STE 3
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8575
Practice Address - Country:US
Practice Address - Phone:317-421-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005064A207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine