Basic Information
| Provider Information | |||||||||
| NPI: | 1942248778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAEGER | ||||||||
| FirstName: | BARBARA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1678 | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323021678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448218137 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 PHILLIPS RD | ||||||||
| Address2: | RADIOLOGY DEPT | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508784127 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0203X | D54487 | MD | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085U0001X | D54487 | MD | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | ME110774 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 004388300 | 05 | FL | MEDICAID | S187 / 0020 | 01 | MD | BLUECHOICE | OTHER | 14H59 | 01 | FL | BCBS OF FL | OTHER | KDA7 / 697567-06 | 01 | MD | BC /BS OF MD | OTHER | 412400600 | 05 | MD | MEDICAID |