Provider Demographics
NPI:1235126582
Name:BAILEY, JIMMIE DALE II (MD)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:DALE
Last Name:BAILEY
Suffix:II
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 1:1001 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:CO
Mailing Address - Zip Code:80734-1854
Mailing Address - Country:US
Mailing Address - Phone:970-854-2500
Mailing Address - Fax:970-854-3887
Practice Address - Street 1:1001 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734-1854
Practice Address - Country:US
Practice Address - Phone:970-854-2500
Practice Address - Fax:970-854-3887
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD. 22758207Q00000X
CODR.0065419207Q00000X
FLME 125949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0065419OtherCO LICENSE NUMBER
CO9000188171Medicaid