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Individual

JACOB BAGLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
81849
WI
207T00000X
Neurological Surgery Physician
A179465
CA
2085N0700X
Neuroradiology Physician
MD205373
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1000248086
WI
Enumeration date
03/31/2014
Last updated
10/18/2023
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