Provider Demographics
NPI:1952346660
Name:JAGGY, JAKOB (MD)
Entity Type:Individual
Prefix:MR
First Name:JAKOB
Middle Name:
Last Name:JAGGY
Suffix:
Gender:M
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 329
Mailing Address - Street 2:22603 PARROTTS FERRY RD
Mailing Address - City:COLUMBIA
Mailing Address - State:CA
Mailing Address - Zip Code:95310-0329
Mailing Address - Country:US
Mailing Address - Phone:209-588-8900
Mailing Address - Fax:209-588-9995
Practice Address - Street 1:22603 PARROTTS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CA
Practice Address - Zip Code:95310-9726
Practice Address - Country:US
Practice Address - Phone:209-588-8900
Practice Address - Fax:209-588-9995
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66760207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A66760Medicare ID - Type Unspecified