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General NPI Number Information
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NPI Number | 1568424356
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Entity Type | Individual
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Provider Name | JOHN CLAUDE BAGWELL MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 203 HOSPITAL DR
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City | RATON
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State | NM
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Zip | 87740-2012
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Country | US
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Telephone | 575-445-7739
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Fax |
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Provider Business Mailing Address
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Address Line | 490A W ZIA RD
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City | SANTA FE
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State | NM
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Zip | 87505-6996
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Country | US
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Telephone | 505-913-8900
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Fax | 505-913-8922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | D3140
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 070527
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 91-4
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License Number State | NM
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