Provider Demographics
NPI:1154448652
Name:BAILEY, EVANS CECIL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EVANS
Middle Name:CECIL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CONCOURSE PKWY
Mailing Address - Street 2:SUITE 265
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1881
Mailing Address - Country:US
Mailing Address - Phone:205-453-4195
Mailing Address - Fax:205-533-7385
Practice Address - Street 1:100 CONCOURSE PKWY
Practice Address - Street 2:SUITE 265
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1881
Practice Address - Country:US
Practice Address - Phone:205-453-4195
Practice Address - Fax:205-533-7385
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085209207N00000X, 390200000X
AL26882207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315021127OtherCONTROLLED SUBSTANCE LICE
511-01156OtherBCBS AL HSV
511-01155OtherBCBS AL MGM
AL511-01154OtherBCBS AL BHAM
AL511-01154OtherBCBS AL BHAM
511-01156OtherBCBS AL HSV