MEDICARE: EARLY BAGGETT DENISON MD

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	208000000X	Pediatrics Physician	L7710	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8P5071	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1508826611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARLY BAGGETT DENISON MD

Provider Business Mailing Address
First Line	:	8355 WALNUT HILL LN
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75231-4219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8355 WALNUT HILL LN
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75231-4219
Country	:	US
Telephone Number	:	214-369-7661
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/16/2007

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