Provider Demographics
NPI:1386680965
Name:BAILEY, BENJAMIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:B
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 1:3007D MEMORIAL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5304
Mailing Address - Country:US
Mailing Address - Phone:256-382-5205
Mailing Address - Fax:256-382-3355
Practice Address - Street 1:3007D MEMORIAL PKWY SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5304
Practice Address - Country:US
Practice Address - Phone:256-382-5205
Practice Address - Fax:256-382-3355
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25465207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051000508OtherBLUE CROSS & BLUE SHIELD
AL051000508OtherBLUE CROSS & BLUE SHIELD
AL051555762Medicare ID - Type Unspecified