Provider Demographics
NPI:1336306356
Name:BAILEY, JESSE ROBERT JR (CERTIFIED SURGICAL A)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:ROBERT
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:CERTIFIED SURGICAL A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 OAKELLAR ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2921
Mailing Address - Country:US
Mailing Address - Phone:813-215-3952
Mailing Address - Fax:
Practice Address - Street 1:3401 OAKELLAR ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2921
Practice Address - Country:US
Practice Address - Phone:813-215-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNCCT503819246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist