Provider Demographics
NPI:1376950998
Name:BAGGETT, DOUG W (DPH)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:W
Last Name:BAGGETT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011
Mailing Address - Country:US
Mailing Address - Phone:918-261-3974
Mailing Address - Fax:406-932-5770
Practice Address - Street 1:136 MCLEOD
Practice Address - Street 2:BOX 1490
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011
Practice Address - Country:US
Practice Address - Phone:918-261-3974
Practice Address - Fax:406-932-5770
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4027183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric