Provider Demographics
NPI:1801010368
Name:WILLIAM J BAGGS MD PA
Entity Type:Organization
Organization Name:WILLIAM J BAGGS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:505-885-2188
Mailing Address - Street 1:2411 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3265
Mailing Address - Country:US
Mailing Address - Phone:575-885-2188
Mailing Address - Fax:575-885-6486
Practice Address - Street 1:2411 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3265
Practice Address - Country:US
Practice Address - Phone:575-885-2188
Practice Address - Fax:575-885-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02188Medicaid
NM0728420001Medicare NSC
NM=========Medicare ID - Type Unspecified
NMC96835Medicare UPIN