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Mr. Brett Gerald Bagley, PA-CERTIFIED
Medical Physician Assistant in Rexburg, Idaho
NPI 1932254133

Brett Gerald Bagley is a Medical Physician Assistant based in Rexburg, ID and is specialized in Medical. Brett Gerald Bagley practices in Rexburg, ID and has the professional credentials of PA-CERTIFIED. The NPI Number for Brett Gerald Bagley is 1932254133 and holds a License No. PA-215 (Idaho).

The current practice location address for Brett Gerald Bagley is 556 Trejo St, Rexburg, ID and can be reached out via phone at 208-359-2263 and via fax at 208-359-2042.

Location: 556 Trejo St, Rexburg, ID, 83440-5405
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Provider Profile Details
NPI Number
1932254133
Provider Name
Brett Gerald Bagley
Credential
PA-CERTIFIED
Provider Entity Type
Individual
Gender
Male
Address
556 Trejo St, Rexburg, ID, 83440-5405
Phone Number
208-359-2263
Fax Number
208-359-2042
Provider Enumeration Date
01/25/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
805069800 05 ID
201139500 01 ID TAX IDENTIFICATION
institution
Provider Business Practice Location Address Details
Address
556 Trejo St
City
State
Zip
83440
Phone Number
208-359-2263
Fax Number
208-359-2042
person
Provider Business Mailing Address Details
Address
556 Trejo St
City
State
Zip
83440
Phone Number
208-359-2263
Fax Number
208-359-2042
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
PA-215 (Idaho)
Definition
Definition to come...
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