Individual
BLAYNE DAVID BAGGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 N LEROY ST, FENTON, MI 48430-2729
(810) 629-9200
(810) 629-9653
Mailing address
305 N LEROY ST, FENTON, MI 48430-2729
(810) 629-9200
(810) 629-9653
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007628
MI
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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