Jordan Lee Bagnall, MD
Student in an Organized Health Care Education/Training Program in Salt Lake City, UT. Individual provider (NPI-1).
Details
- NPI
- 1497558985
- Entity type
- Individual (NPI-1)
- Name
- Jordan Lee Bagnall
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 31, 2025
- Certification date
- Mar 30, 2025
- Last updated
- Mar 31, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
195 Central Campus DrSalt Lake City, UT 84112-0519
Phone 801-581-3811
Mailing address
1505 Broad Ave Apt ACharlottesville, VA 22903-3721
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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