Organization Name: | ERNEST A BAGNER III MD INC |
NPI Number: | 1497776314 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERNEST A BAGNER (PRESIDENT) |
Mailing Address: | 541 W Colorado St 207 Glendale |
State: | CA US |
Postal Code: | 912043638 |
Phone Number: | 8182919827 |
Fax Number: | 8182919822 |
NPI Enumeration Date: | 07/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | W19781 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |