MEDICARE: DR. STEPHEN BAGNOLI M.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
1	207RP1001X	Pulmonary Disease Physician	ME0045005	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649270638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN BAGNOLI M.D.

Provider Business Mailing Address
First Line	:	3599 UNIVERSITY BLVD S
Second Line	:	SUITE 901
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4252
Country	:	US
Telephone Number	:	904-398-6971
Fax Number	:	904-398-2497

Provider Business Practice Location Address
First Line	:	3599 UNIVERSITY BLVD S
Second Line	:	SUITE 901
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4252
Country	:	US
Telephone Number	:	904-398-6971
Fax Number	:	904-398-2497

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

Provider Enumeration Date	:	07/31/2005
Last Update Date	:	04/08/2014

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Directions to “ DR. STEPHEN BAGNOLI M.D.” Practice Location

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