Dr. Beau J Bagley, MD
Physical Medicine & Rehabilitation in Covington, LA. Individual provider (NPI-1).
NPI number1366439572
StatusActive
Last updated in NPPESMar 30, 2013
Details
- NPI
- 1366439572
- Entity type
- Individual (NPI-1)
- Name
- Dr. Beau J Bagley
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 3, 2005
- Last updated
- Mar 30, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 14743R | LA | Yes |
| 208100000X | Physical Medicine & Rehabilitation | 26611 | AL |
Practice location
1331 Ochsner BlvdSuite 100
Covington, LA 70433-8177
Phone 985-234-0490
Mailing address
Po Box 2013Mandeville, LA 70470-2013
Phone 504-237-1430
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