Provider Demographics
NPI:1316005143
Name:BAILEY, RONALD WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WESLEY
Last Name:BAILEY
Suffix:
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 1:708 MICHAELS CRK
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4042
Mailing Address - Country:US
Mailing Address - Phone:706-868-0972
Mailing Address - Fax:
Practice Address - Street 1:MOUNTAIN HOME AFB MEDICAL GROUP
Practice Address - Street 2:90 HOPE DRIVE, BUILDING 6000
Practice Address - City:MOUNTAIN HOME AFB
Practice Address - State:ID
Practice Address - Zip Code:83648
Practice Address - Country:US
Practice Address - Phone:208-828-7815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA665632085R0202X, 208D00000X
NC2000-007132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE99110Medicare UPIN