Individual
JORDAN LEE BAGNALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
195 CENTRAL CAMPUS DR, SALT LAKE CITY, UT 84112-0519
(801) 581-3811
Mailing address
1505 BROAD AVE APT A, CHARLOTTESVILLE, VA 22903-3721
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/31/2025
Last updated
03/31/2025
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