Family Practice of Jay County

NPI #1982749867 in Portland, Indiana

Provider Information

NPI Number: 1982749867
Entity Type: Organization
Organization Name: Family Practice of Jay County
Subpart: Yes (part of a larger organization)
Parent Organization: JAY COUNTY HOSPITAL
Primary Specialty: Family Medicine
Enumeration Date: Feb 20, 2007
Last Updated: Sep 23, 2010

Practice Location

Address: 428 WEST VOTAW STREET, STE. A
City: Portland
State: Indiana
ZIP Code: 47371-0710
Phone: (260) 726-8822

Authorized Official

Name: DR. MARK ALLEN HAGGENJOS, D.O.
Title: MANAGING PHYSICIAN
Phone: (260) 726-8822

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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