Provider Demographics
NPI:1407875008
Name:BAILEY, ROBIN KEITH (PA-C, MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:KEITH
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PA-C, MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:KEITH
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C, MD
Mailing Address - Street 1:318 TRAPPERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-8573
Mailing Address - Country:US
Mailing Address - Phone:727-433-2179
Mailing Address - Fax:
Practice Address - Street 1:318 TRAPPERS RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-8573
Practice Address - Country:US
Practice Address - Phone:727-433-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2145363A00000X
NC101393208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292305000Medicaid
FLS76912Medicare UPIN
FLP00446103Medicare PIN
FLE2313YMedicare PIN
FLE2313XMedicare PIN