Bagley, Brett Gerald
Bagley, Brett Gerald is an sole proprietor health care provider with primary practice located at 556 Trejo St Suite B, Rexburg ID 83440. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Bagley, Brett Gerald can be contacted via phone (208) 359-2263.Contact Information
Primary practice address
556 Trejo St Suite B
Rexburg ID 83440
Phone: (208) 359-2263
Fax: (208) 359-2042
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA-215 | Idaho |
Profile Details
| NPI number | 1932254133 |
|---|---|
| LBN Legal business name | Bagley, Brett Gerald |
| Credentials | P.A. - CERTIFIED |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 25th, 2007 |
| Last updated | Jun 26th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932254133 | NPPES |
| Idaho | MEDICAID | 805069800 | |
| Idaho | Other | 201139500 |
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