Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 2015-01992 | NC |
NPI | 1891999322 |
---|---|
Provider Name | Namory Bagayoko |
First Address | Anchorage, AK 99508-5926 |
Second Address | Anchorage, AK 99508-5926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 11/09/2018 |