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NPI Code Detail

MEDICARE: BLAYNE DAVID BAGGETT

MEDICARE: BLAYNE DAVID BAGGETT
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
1363A00000XPhysician Assistant5601007628MI

General Provider Information

NPI Number : 1114382637
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAYNE DAVID BAGGETT
Provider Business Mailing Address
First Line : 305 N LEROY ST
Second Line :
City : FENTON
State : MI
Zip : 48430-2729
Country : US
Telephone Number : 810-629-9200
Fax Number : 810-629-9653
Provider Business Practice Location Address
First Line : 305 N LEROY ST
Second Line :
City : FENTON
State : MI
Zip : 48430-2729
Country : US
Telephone Number : 810-629-9200
Fax Number : 810-629-9653
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2015
Last Update Date : 12/29/2015

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Directions to “ BLAYNE DAVID BAGGETT ” Practice Location

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