Provider Demographics
NPI:1437145174
Name:BAILEY, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
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 1:4310 JAMES CASEY ST
Mailing Address - Street 2:BUILDING 1 SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-504-7411
Mailing Address - Fax:512-215-8824
Practice Address - Street 1:4310 JAMES CASEY ST.
Practice Address - Street 2:BUILDING 1 SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-504-7411
Practice Address - Fax:512-215-8824
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1485207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179907401Medicaid
TX378596ZSQTOtherPTAN
TX378596ZSQTOtherPTAN
H20915Medicare UPIN
TX8D8996Medicare PIN
TXH20915Medicare UPIN