Healthcare Provider Details

I. General information

NPI: 1881618742
Provider Name (Legal Business Name): STEPANKA BAGGETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 S PEACHTREE ST
JASPER TX
75951-4916
US

IV. Provider business mailing address

1276 S PEACHTREE ST
JASPER TX
75951-4916
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-5701
  • Fax: 409-384-9820
Mailing address:
  • Phone: 409-384-5701
  • Fax: 409-384-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM1484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: