Provider Demographics
NPI:1649369109
Name:THE PADDY JIM BAGGOT MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:THE PADDY JIM BAGGOT MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAGGOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-448-0213
Mailing Address - Street 1:3020 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1120
Mailing Address - Country:US
Mailing Address - Phone:213-386-2606
Mailing Address - Fax:213-386-2603
Practice Address - Street 1:3020 WILSHIRE BLVD
Practice Address - Street 2:SUITE #219
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1120
Practice Address - Country:US
Practice Address - Phone:213-386-2606
Practice Address - Fax:213-386-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G849160Medicaid