Individual
DR. GROVER CARLTON BAGBY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-6594
Mailing address
3738 SW COUNCIL CREST DR, PORTLAND, OR 97239-1522
(503) 248-9216
(503) 721-7946
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
MD07879
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130248
—
OR
Enumeration date
10/09/2006
Last updated
01/29/2009
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