Provider Demographics
NPI:1881878932
Name:MATTHEW BAGAN DO PA
Entity type:Organization
Organization Name:MATTHEW BAGAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-743-4150
Mailing Address - Street 1:18308 MURDOCK CIRCLE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1008
Mailing Address - Country:US
Mailing Address - Phone:941-743-4150
Mailing Address - Fax:941-743-4427
Practice Address - Street 1:18308 MURDOCK CIRCLE
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1008
Practice Address - Country:US
Practice Address - Phone:941-743-4150
Practice Address - Fax:941-743-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty