Provider Demographics
NPI:1477571974
Name:BAYLISS, SUSAN JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOY
Last Name:BAYLISS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8123-29-10014
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-273-3376
Mailing Address - Fax:833-642-0691
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 2A AND 2D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2714
Practice Address - Fax:833-642-0691
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7N88207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202910808Medicaid
ILENROLLEDMedicaid