Provider Demographics
NPI:1093847717
Name:BAILEY, CHAD RYAN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:RYAN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1947
Mailing Address - Country:US
Mailing Address - Phone:214-223-3200
Mailing Address - Fax:
Practice Address - Street 1:8380 WARREN PKWY
Practice Address - Street 2:SUITE 504
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4198
Practice Address - Country:US
Practice Address - Phone:972-596-4005
Practice Address - Fax:972-985-1253
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04810363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical