Individual
JACK LLORRAC BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2208 S 17TH ST, WILMINGTON, NC 28401-7593
(910) 763-3333
Mailing address
PO BOX 96860, CHARLOTTE, NC 28296-6860
(704) 542-6111
(704) 542-1239
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103055
NC
363A00000X
Physician Assistant
2006004610
MO
Other
Enumeration date
06/06/2006
Last updated
04/06/2026
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