Basic Information
| Provider Information | |||||||||
| NPI: | 1114116910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY J. HAGGENJOS, D.O., INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 231 | ||||||||
| Address2: | |||||||||
| City: | NEW LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437640231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403434447 | ||||||||
| FaxNumber: | 7403434451 | ||||||||
| Practice Location | |||||||||
| Address1: | 399 LINCOLN PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NEW LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437641078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403434447 | ||||||||
| FaxNumber: | 7403434451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | HAGGENJOS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | JORDAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7403444447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 34-002872 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.