Provider Demographics
NPI:1528152501
Name:BAGBY, CHRISTOPHER A (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:BAGBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 BAPTISTE DR STE E
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1314
Mailing Address - Country:US
Mailing Address - Phone:913-557-3800
Mailing Address - Fax:913-557-5689
Practice Address - Street 1:2102 BAPTISTE DR STE E
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1314
Practice Address - Country:US
Practice Address - Phone:913-557-3800
Practice Address - Fax:913-557-5989
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26156207X00000X, 207X00000X
MO110169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14520Medicare UPIN