Dr Kory St John Jaggon, MBBS | |
100 E Carroll St, Salisbury, MD 21801-5422 | |
(410) 546-6400 | |
Not Available |
Full Name | Dr Kory St John Jaggon |
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Gender | Male |
Speciality | Hospitalist |
Location | 100 E Carroll St, Salisbury, Maryland |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1558989822 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208M00000X | Hospitalist | D0095532 (Maryland) | Primary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
Entity Name | Tidalhealth Specialty Care Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1619504735 PECOS PAC ID: 7113340845 Enrollment ID: O20200714000286 |
Mailing Address | Practice Location Address |
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Dr Kory St John Jaggon, MBBS 100 E Carroll St, Salisbury, MD 21801-5422 Ph: (410) 546-6400 | Dr Kory St John Jaggon, MBBS 100 E Carroll St, Salisbury, MD 21801-5422 Ph: (410) 546-6400 |
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