Provider Demographics
NPI:1235472176
Name:BAGAYOKO, COURTNEY WEATHERSBY (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:WEATHERSBY
Last Name:BAGAYOKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:WEATHERSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:615 E 82ND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3159
Mailing Address - Country:US
Mailing Address - Phone:907-865-8455
Mailing Address - Fax:913-246-4901
Practice Address - Street 1:615 E 82ND AVE STE 204
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3159
Practice Address - Country:US
Practice Address - Phone:907-865-8455
Practice Address - Fax:913-246-4901
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK124372207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology