Provider Demographics
NPI:1114979796
Name:BAILEY, MARK LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 SHIRE BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2236
Mailing Address - Country:US
Mailing Address - Phone:972-487-6400
Mailing Address - Fax:972-487-1686
Practice Address - Street 1:3600 SHIRE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2236
Practice Address - Country:US
Practice Address - Phone:972-487-6400
Practice Address - Fax:972-487-1686
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH2226208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115376902Medicaid
TX115376902Medicaid
TX89091FMedicare PIN