Individual
DR. MICHAEL BRIAN BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2778 HIGHWAY 51 S, SENATOBIA, MS 38668-9403
(662) 560-5966
(662) 560-5969
Mailing address
2778 HIGHWAY 51 S, SENATOBIA, MS 38668-9403
(662) 560-5966
(662) 560-5969
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19146
MS
207Q00000X
Family Medicine Physician
Primary
19146
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08085016
—
MS
Enumeration date
06/18/2006
Last updated
07/01/2021
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