Individual
DR. JONATHAN BAGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, DEPARTMENT OF ANESTHESIOLOGY, JACKSON, MS 39216-4500
(601) 984-5914
(601) 984-5915
Mailing address
2500 N STATE ST, DEPARTMENT OF ANESTHESIOLOGY, JACKSON, MS 39216-4500
(601) 984-5914
(601) 984-5915
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
T-2531
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-2531
TEMPORARY LICENSES
MS
Enumeration date
06/29/2012
Last updated
06/29/2012
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