Provider Demographics
NPI:1265545719
Name:BAGGETT, GARY (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BAGGETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-8710
Mailing Address - Country:US
Mailing Address - Phone:704-825-3605
Mailing Address - Fax:
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:EMERGENCY CENTER
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6000
Practice Address - Fax:864-560-4413
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005488L207P00000X
SC997207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC198714OtherMEDCOST
SCP00879457OtherRAILROAD MEDICARE
SC20062701OtherSELECT HEALTH
SC009975Medicaid
SC5912089OtherAETNA
NC5906417Medicaid
SCB95017Medicare PIN
NC5906417Medicaid
SCB950179068Medicare PIN
SC20062701OtherSELECT HEALTH
SCP00397784Medicare PIN