Provider Demographics
NPI:1467448894
Name:BAILEY, ROLLAND L (DO)
Entity Type:Individual
Prefix:MR
First Name:ROLLAND
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ROLLAND
Other - Middle Name:L
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO, PA
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:806 E MAIN
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-0309
Mailing Address - Country:US
Mailing Address - Phone:870-453-2266
Mailing Address - Fax:870-453-2307
Practice Address - Street 1:806 E MAIN
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634-0309
Practice Address - Country:US
Practice Address - Phone:870-453-2266
Practice Address - Fax:870-453-2307
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN6958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110982003Medicaid
50199Medicare ID - Type Unspecified
C67764Medicare UPIN
AR110982003Medicaid