Provider Demographics
NPI:1780694067
Name:JAGGERS, PATRICIA C (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:C
Last Name:JAGGERS
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:P.O. BOX 10005
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-2005
Mailing Address - Country:US
Mailing Address - Phone:256-768-8350
Mailing Address - Fax:256-768-9187
Practice Address - Street 1:105 FIRE STATION RD
Practice Address - Street 2:
Practice Address - City:BAILEYTON
Practice Address - State:AL
Practice Address - Zip Code:35019-9609
Practice Address - Country:US
Practice Address - Phone:256-735-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13474207P00000X, 207R00000X
VA0101050261207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA172004OtherANTHEM BS
VA6006973Medicaid
VA110005068Medicare PIN