Healthcare Provider Details

I. General information

NPI: 1487677308
Provider Name (Legal Business Name): ERIC SCOTT BAGGSTROM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 S WOODS MILL RD STE 220
TOWN AND COUNTRY MO
63017-8333
US

IV. Provider business mailing address

1068 S WOODS MILL RD STE 220
TOWN AND COUNTRY MO
63017-8333
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-1379
  • Fax: 314-394-1377
Mailing address:
  • Phone: 314-394-1379
  • Fax: 314-394-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2004036761
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004036761
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: