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Individual
ROMAN SHAWN BAGWELL
Active
Individual
ROMAN SHAWN BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
727514
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186791301
—
TX
05
—
186791302
—
TX
05
—
186791303
—
TX
01
—
75-1976930-005
TRICARE
TX
01
—
8338UE
BCBS
TX
01
—
86716U
BCBS
TX
01
—
P01246266
RAIL ROAD
TX
01
—
TIN PLUS 015
TRICARE
TX
Enumeration date
06/16/2006
Last updated
12/08/2014
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