Provider Demographics
NPI:1649595216
Name:BAGLEY, ADAM WALKER (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WALKER
Last Name:BAGLEY
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 1:2100 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5130
Mailing Address - Country:US
Mailing Address - Phone:904-276-0001
Mailing Address - Fax:904-276-5333
Practice Address - Street 1:2100 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5130
Practice Address - Country:US
Practice Address - Phone:904-276-0001
Practice Address - Fax:904-276-5333
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123101207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01510416OtherRR MEDICARE
FL014634200Medicaid
FL014634200Medicaid