MEDICARE: JACKSON PHILIP BAGBY DO

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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	2020235730	MO
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	2022035730	MO

General Provider Information

NPI Number	:	1134707045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON PHILIP BAGBY DO

Provider Business Mailing Address
First Line	:	121 CAHILL RD STE 206
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-1911
Country	:	US
Telephone Number	:	417-348-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 CAHILL RD STE 206
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-1911
Country	:	US
Telephone Number	:	417-348-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	12/08/2025

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Directions to “ JACKSON PHILIP BAGBY DO” Practice Location

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