Individual
JACOB BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
COURTHOUSE RD, BUILDING A66, CAMP LEJEUNE, NC 28547
(910) 440-7925
Mailing address
5185 COLORADO AVE, CAMP LEJEUNE, NC 28547-1126
(412) 780-8250
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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