Provider Demographics
NPI:1669541165
Name:BAGGETT, MARK R (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:BAGGETT
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:2004 MARION ST D
Mailing Address - Street 2:PSYCHOLOGICAL APPLICATION. DR.
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-432-6833
Mailing Address - Fax:910-432-9197
Practice Address - Street 1:2004 MARION ST D
Practice Address - Street 2:PSYCHOLOGICAL APPLICATION. DR.
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-432-6833
Practice Address - Fax:910-432-9197
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL872103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist