Healthcare Provider Details

I. General information

NPI: 1962588053
Provider Name (Legal Business Name): ANDREW SCOTT BAGG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR SUITE 315
ALTAMONTE SPRINGS FL
32701-5105
US

IV. Provider business mailing address

661 E ALTAMONTE DR SUITE 315
ALTAMONTE SPRINGS FL
32701-5105
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-3002
  • Fax: 407-260-5039
Mailing address:
  • Phone: 407-339-3002
  • Fax: 407-260-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 95484
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME95484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: