Provider Demographics
NPI:1891765020
Name:BAGGE, DOUGLAS ROY (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ROY
Last Name:BAGGE
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 1:1311A N MILDRED RD
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1311A N MILDRED RD
Practice Address - Street 2:STE A
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3121
Practice Address - Country:US
Practice Address - Phone:970-564-2681
Practice Address - Fax:970-564-2682
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34570207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345701Medicaid
CO01345701Medicaid
COG13124Medicare UPIN