| Doctor Name: | MR. ROBERT STEVEN BAGWELL |
| NPI Number: | 1083922132 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CDC-II |
| License Number: | |
| Business Practice Address: | 325 S 5th St Klamath Falls, OR - 976016107 |
| Business Phone Number: | 5418827111 |
| Business Fax Number: | 5418827111 |
| Mailing Address: | 325 S 5th St, KLAMATH FALLS |
| State: | OR |
| Postal Code: | 976016107 |
| Phone Number: | 5418827111 |
| Fax Number: | 5418827111 |
| NPI Enumeration Date: | 09/22/2010 |
| NPI Last Update Date: | 05/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |