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General NPI Number Information
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NPI Number | 1245403666
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Entity Type | Organization
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Legal Business Name | OLIVER DALE BAGLEY D.P.M., INC.
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 1310 CONTINENTAL ST
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City | REDDING
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State | CA
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Zip | 96001-0839
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Country | US
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Telephone | 530-244-0674
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Fax | 530-244-1033
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Provider Business Mailing Address
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Address Line | 1310 CONTINENTAL ST
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City | REDDING
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State | CA
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Zip | 96001-0839
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Country | US
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Telephone | 530-244-0674
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Fax | 530-244-1033
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLIVER D. BAGLEY
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Credential | D.P.M.
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Telephone | 530-244-0674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E1237
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | E1237
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License Number State | CA
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