Provider Demographics
NPI:1316173834
Name:THE PADDY JIM BAGGOT MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:THE PADDY JIM BAGGOT MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAGGOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-960-7777
Mailing Address - Street 1:1535 W MERCED AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3404
Mailing Address - Country:US
Mailing Address - Phone:626-960-7777
Mailing Address - Fax:626-338-3975
Practice Address - Street 1:1535 W MERCED AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3404
Practice Address - Country:US
Practice Address - Phone:626-960-7777
Practice Address - Fax:626-338-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84916207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G849160Medicare UPIN