Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 14448 | OK |
NPI | 1801032297 |
---|---|
Provider Name | Dr. Lynn Dean Baggett |
First Address | Konawa, OK 74849-1415 |
Second Address | Konawa, OK 74849-1415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2009 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14448 | OK BOARD OF MEDICAL LICENSURE AND SUPERVISION (01) | OK |