Organization
GULF COAST BRAIN SPORT & SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEAU J BAGLEY MD (OWNER)
(504) 237-1430
Entity
Organization
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
Other
Enumeration date
08/24/2011
Last updated
03/30/2013
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