Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 27520 | IA |
Y | 208600000X | Surgeon | 27520 | IA |
NPI | 1013919653 |
---|---|
Provider Name | Wesley Riggs Bagan |
First Address | Fort Madison, IA 52627-9601 |
Second Address | Fort Madison, IA 52627-9601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 01/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1061614 | (05) | IA |
152975 | IOWA HEALTH SOLUTIONS (01) | IA |
19555 | WELLMARK BLUE CROSS (01) | IA |
A72522 | (02) | IA |
IA0128 | JOHN DEERE HEALTH (01) | IA |