Provider Demographics
NPI:1205815115
Name:BAILEY, THOMAS DANIEL (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DANIEL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1034 MAR WALT DR UNIT 200
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6637
Mailing Address - Country:US
Mailing Address - Phone:850-862-4001
Mailing Address - Fax:850-862-1612
Practice Address - Street 1:911 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6705
Practice Address - Country:US
Practice Address - Phone:850-862-4001
Practice Address - Fax:850-862-1612
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000048004207W00000X
FLME107366207W00000X
NC26182207W00000X
SC16937207W00000X
GA78997207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
204582BMedicare ID - Type Unspecified
B07986Medicare UPIN
NC8912632Medicaid