Provider Demographics
NPI:1639402878
Name:BAGLEY, THOMAS (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 BELLA LN
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-9086
Mailing Address - Country:US
Mailing Address - Phone:706-717-0803
Mailing Address - Fax:251-955-6969
Practice Address - Street 1:3914 BELLA LN
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-9086
Practice Address - Country:US
Practice Address - Phone:706-717-0803
Practice Address - Fax:251-955-6969
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1040907163W00000X
GARN062994367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse