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NPI Code Detail

MEDICARE: DR. ROBERT BAGLEY PH.D.

MEDICARE: DR. ROBERT BAGLEY PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist6119664-3904UT

General Provider Information

NPI Number : 1083720601
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT BAGLEY PH.D.
Provider Business Mailing Address
First Line : 5662 SHADY FARM LN
Second Line :
City : MURRAY
State : UT
Zip : 84107-6714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 32 W WINCHESTER ST
Second Line : SUITE 101
City : SALT LAKE CITY
State : UT
Zip : 84107-5607
Country : US
Telephone Number : 801-263-6367
Fax Number : 801-263-6370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 07/08/2007

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