Provider Demographics
NPI:1265451827
Name:BAILEY, JOSEPH BRADY (MD, MBA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRADY
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S BEVERLY DR
Mailing Address - Street 2:#1008
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3851
Mailing Address - Country:US
Mailing Address - Phone:702-821-5732
Mailing Address - Fax:702-878-4313
Practice Address - Street 1:269 S BEVERLY DR
Practice Address - Street 2:#1008
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3851
Practice Address - Country:US
Practice Address - Phone:702-821-5732
Practice Address - Fax:702-878-4313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0020*18902Medicaid
H45612Medicare UPIN
NV0020*18902Medicaid