Individual
JAY E HAGGERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-2000
Mailing address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PG154676
OR
2085N0700X
Neuroradiology Physician
Primary
036159330
IL
2085R0202X
Diagnostic Radiology Physician
61545
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61545
MD LICENSE
MN
Enumeration date
05/13/2011
Last updated
07/15/2025
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