Provider Demographics
NPI:1487677308
Name:BAGGSTROM, ERIC SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SCOTT
Last Name:BAGGSTROM
Suffix:
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 1:1068 S WOODS MILL RD STE 220
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8333
Mailing Address - Country:US
Mailing Address - Phone:314-394-1379
Mailing Address - Fax:314-394-1377
Practice Address - Street 1:1068 S WOODS MILL RD STE 220
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-8333
Practice Address - Country:US
Practice Address - Phone:314-394-1379
Practice Address - Fax:314-394-1377
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004036761208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209094606Medicaid
MO209094606Medicaid
G79263Medicare UPIN
IL$$$$$$$$$Medicaid
MO209094606Medicaid
P00264019Medicare PIN