Individual
ANDREW BAGULEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2426 N MERRITT CREEK LOOP STE A, COEUR D ALENE, ID 83814-4961
(208) 819-2183
(208) 209-6063
Mailing address
PO BOX 3687, COEUR D ALENE, ID 83816-2529
(208) 819-2183
(208) 209-6063
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-153622
MT
Other
Enumeration date
04/24/2025
Last updated
04/25/2025
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