Provider Demographics
NPI:1649547985
Name:BRAGG, JOHN STUART JR (CHP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STUART
Last Name:BRAGG
Suffix:JR
Gender:M
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 N BLACK BEAR CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-1808
Mailing Address - Country:US
Mailing Address - Phone:907-521-6442
Mailing Address - Fax:907-563-2891
Practice Address - Street 1:1840 BRAGAW ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3401
Practice Address - Country:US
Practice Address - Phone:907-562-4155
Practice Address - Fax:907-563-2891
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker