Provider Demographics
NPI:1053365213
Name:BAGLEY, TERRY L (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1776 WOODSTEAD CT
Mailing Address - Street 2:STE 208
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1480
Mailing Address - Country:US
Mailing Address - Phone:281-724-3100
Mailing Address - Fax:281-724-3100
Practice Address - Street 1:3700 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1253
Practice Address - Country:US
Practice Address - Phone:928-772-6951
Practice Address - Fax:928-772-6971
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2020-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ31433208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC9137OtherRAILROAD MEDICARE
AZAZ0765480OtherBLUE CROSS BLUE SHIELD
AZ914300Medicaid
AZG81232Medicare UPIN
AZDC9137OtherRAILROAD MEDICARE