Individual
JEFFREY W. BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1391 N BALDWIN AVE, MARION, IN 46952-1913
(765) 662-2534
(765) 671-7793
Mailing address
330 NORTH WABASH, STE G20, MARION, IN 46952-2600
(765) 662-4133
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000919
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000661496
ANTHEM
IN
05
—
100260500
—
IN
Enumeration date
01/23/2006
Last updated
10/21/2020
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