Jordan Lee Bagnall, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Salt Lake City, UT
NPI 1497558985 · NPPES record last updated Mar 31, 2025
Key facts
- NPI
- 1497558985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 195 Central Campus Dr
Salt Lake City, UT 84112-0519 - Phone
- (801) 581-3811
- NPI assigned
- Mar 31, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
195 Central Campus Dr
Salt Lake City, UT 84112-0519
Mailing address
1505 Broad Ave Apt a
Charlottesville, VA 22903-3721
Other providers in Salt Lake City, UT
- Kimra Bagley
- Lisa Dunn Bagley
- Robert Bagley
- Sandra W Bagley
- Tricia Bagley
- Roxana Bahani
- Stephanie Bahena Alvarez
- Leticia Bahena
- David W. Bahler
- Albert L Bahr
All providers in Salt Lake City, UT · Student in an Organized Health Care Education/Training Program in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.