Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 31433 | AZ |
NPI | 1053365213 |
---|---|
Provider Name | Dr. Terry L Bagley |
First Address | The Woodlands, TX 77380-1480 |
Second Address | Prescott Valley, AZ 86314-1253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
914300 | (05) | AZ |
AZ0765480 | BLUE CROSS BLUE SHIELD (01) | AZ |
DC9137 | RAILROAD MEDICARE (01) | AZ |
G81232 | (02) | AZ |