Bagwell, Roman Shawn

Bagwell, Roman Shawn is an individual health care provider with primary practice located at 800 E Dawson St , Tyler TX 75701-2036. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Bagwell, Roman Shawn can be contacted via phone (903) 531-4500.

Contact Information

Primary practice address
800 E Dawson St Tyler TX 75701-2036
Phone: (903) 531-4500
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 727514 Texas

Profile Details

NPI number 1689618787
LBN Legal business name Bagwell, Roman Shawn
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Dec 8th, 2014 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689618787 NPPES
Texas MEDICAID 186791301
Texas MEDICAID 186791303
Texas Other 86716U
Texas Other TIN PLUS 015
Texas Other 75-1976930-005
Texas Other P01246266
Texas MEDICAID 186791302
Texas Other 8338UE

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