Provider Demographics
NPI:1861472508
Name:BAGGETT, RONALD W (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:BAGGETT
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 1:103 DAVIS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2731
Mailing Address - Country:US
Mailing Address - Phone:281-538-1003
Mailing Address - Fax:281-535-2240
Practice Address - Street 1:103 DAVIS RD
Practice Address - Street 2:SUITE C
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2731
Practice Address - Country:US
Practice Address - Phone:281-538-1003
Practice Address - Fax:281-535-2240
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2350207P00000X, 208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21056Medicare UPIN