Individual
PETER LOREN JAGGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 GRANT ST, EVANSTON, IL 60201
(847) 492-4828
(847) 492-4810
Mailing address
3200 GRANT ST, EVANSTON, IL 60201-1903
(847) 492-4842
(847) 492-4829
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036062564
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110213053
RAILROAD MEDICARE
IL
Enumeration date
03/15/2006
Last updated
12/14/2015
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