Provider Demographics
NPI:1407819295
Name:BAGAN, MATTHEW R (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:BAGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18308 MURDOCK CIR UNIT 105
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1025
Mailing Address - Country:US
Mailing Address - Phone:941-743-4150
Mailing Address - Fax:941-743-4427
Practice Address - Street 1:18308 MURDOCK CIR
Practice Address - Street 2:UNIT 105
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1025
Practice Address - Country:US
Practice Address - Phone:941-743-4150
Practice Address - Fax:941-743-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2502907OtherCIGNA
FL7657446OtherAETNA
FLP01271765OtherRAILROAD MCR
FLP01809468OtherCLEAR HEALTH ALLIANCE
FLP109659OtherFREEDOM HEALTH
FL324872OtherAVMED
FL001521900Medicaid
FL240249OtherWELLCARE
FLP951432OtherOPTIMUM
FLP01271765OtherRAILROAD MCR
FL2502907OtherCIGNA
FL001521900Medicaid