Healthcare Provider Details

I. General information

NPI: 1053365213
Provider Name (Legal Business Name): TERRY L BAGLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13451 N 94TH DR
PEORIA AZ
85381-5056
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 623-303-7101
  • Fax:
Mailing address:
  • Phone: 281-724-3100
  • Fax: 281-724-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number31433
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: