Healthcare Provider Details

I. General information

NPI: 1801010368
Provider Name (Legal Business Name): WILLIAM J BAGGS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 OSBORNE RD
CARLSBAD NM
88220-3265
US

IV. Provider business mailing address

2411 OSBORNE RD
CARLSBAD NM
88220-3265
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-2188
  • Fax: 575-885-6486
Mailing address:
  • Phone: 575-885-2188
  • Fax: 575-885-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number77125
License Number StateNM

VIII. Authorized Official

Name: DR. WILLIAM J BAGGS
Title or Position: OWNER
Credential: MD PA
Phone: 505-885-2188