Provider Demographics
NPI:1235324435
Name:GREGORY N BAILEY PAC INC
Entity Type:Organization
Organization Name:GREGORY N BAILEY PAC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-558-9522
Mailing Address - Street 1:6175 NW 153RD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2435
Mailing Address - Country:US
Mailing Address - Phone:305-558-9522
Mailing Address - Fax:305-558-9520
Practice Address - Street 1:6175 NW 153RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2435
Practice Address - Country:US
Practice Address - Phone:305-558-9522
Practice Address - Fax:305-558-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101559363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9101559OtherPROF LICENSE
FLP78153Medicare UPIN