Provider Demographics
NPI:1164415543
Name:BAGBY, RICHARD A JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BAGBY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 HOSPITAL RD
Mailing Address - Street 2:STE G
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2470
Mailing Address - Country:US
Mailing Address - Phone:931-962-2272
Mailing Address - Fax:931-967-8119
Practice Address - Street 1:183 HOSPITAL RD
Practice Address - Street 2:STE G
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2470
Practice Address - Country:US
Practice Address - Phone:931-962-2272
Practice Address - Fax:931-962-8588
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMDO11925207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
407202037OtherRAILROAD MEDICARE
2009891OtherBLUE CROSS
TN2009891Medicaid
TN621117715OtherAMERICHOICE TENNCARE
407202037OtherRAILROAD MEDICARE
TN0895260001Medicare NSC
TN2009891Medicaid
TN0895260001Medicare NSC