Healthcare Provider Details

I. General information

NPI: 1679952972
Provider Name (Legal Business Name): JOEL KEVIN BAGLEY II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E # 1C412
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2401
  • Fax:
Mailing address:
  • Phone: 970-564-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0067097
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: