Provider Demographics
NPI:1780604223
Name:BACCUS, VIRGIL THOMAS (MD)
Entity type:Individual
Prefix:
First Name:VIRGIL
Middle Name:THOMAS
Last Name:BACCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 AL HWY 157
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058
Mailing Address - Country:US
Mailing Address - Phone:256-739-2626
Mailing Address - Fax:256-739-6588
Practice Address - Street 1:1890 AL HWY 157
Practice Address - Street 2:SUITE 220
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058
Practice Address - Country:US
Practice Address - Phone:256-739-2626
Practice Address - Fax:256-739-6588
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5397207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4044923OtherAETNA
ALC74617Medicare UPIN