Bagby, Grover Carlton
Bagby, Grover Carlton is an individual health care provider with primary practice located at 3181 Sw Sam Jackson Park Rd , Portland OR 97239-3011. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology, which is considered as his primary health care specialty. Bagby, Grover Carlton can be contacted via phone (503) 494-6594.Contact Information
Primary practice address
3181 Sw Sam Jackson Park Rd
Portland OR 97239-3011
Phone: (503) 494-6594
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hematology | 207RH0000X | MD07879 | Oregon |
Profile Details
| NPI number | 1962599910 |
|---|---|
| LBN Legal business name | Bagby, Grover Carlton |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 9th, 2006 |
| Last updated | Jan 29th, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962599910 | NPPES |
| Oregon | MEDICAID | 130248 |
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