Individual
JENS BAGGESEN FLOCK IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 425-4000
Mailing address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 425-4000
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
ME146639
FL
390200000X
Student in an Organized Health Care Education/Training Program
201153
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201153
—
NC
Enumeration date
04/02/2014
Last updated
10/08/2020
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