Provider Demographics
NPI:1467436071
Name:BAILON, GLADYS (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:
Last Name:BAILON
Suffix:
Gender:F
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:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1249
Mailing Address - Country:US
Mailing Address - Phone:907-260-7784
Mailing Address - Fax:
Practice Address - Street 1:161 N BINKLEY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7521
Practice Address - Country:US
Practice Address - Phone:907-260-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA4445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD54821Medicaid
H67095Medicare UPIN
K160122Medicare PIN