Individual
DR. BEAU J BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1331 OCHSNER BLVD, SUITE 100, COVINGTON, LA 70433-8177
(985) 234-0490
Mailing address
PO BOX 2013, MANDEVILLE, LA 70470-2013
(504) 237-1430
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
14743R
LA
208100000X
Physical Medicine & Rehabilitation Physician
26611
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932699
—
AL
01
—
051528942
BCBS PROVIDER NUMBER
AL
Enumeration date
10/03/2005
Last updated
03/30/2013
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