Individual
DR. BO BAGENHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1704 DUFFY LOOP, THE VILLAGES, FL 32162-4093
(352) 350-2530
(352) 350-2530
Mailing address
1704 DUFFY LOOP, THE VILLAGES, FL 32162-4093
(352) 350-2530
(352) 350-2530
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME24950
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50474-2
—
FL
Enumeration date
02/02/2011
Last updated
02/02/2011
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