Provider Demographics
NPI:1508801754
Name:BAILEY, RICHARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
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 1:686 S HIGHWAY 25 W
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1604
Mailing Address - Country:US
Mailing Address - Phone:606-549-5052
Mailing Address - Fax:606-549-2718
Practice Address - Street 1:686 S HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1604
Practice Address - Country:US
Practice Address - Phone:606-549-5052
Practice Address - Fax:606-549-2718
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000316055OtherANTHEM
KY64079056Medicaid
KY030534227OtherTAX ID
KY64079056Medicaid
0901501Medicare PIN
KYG10548Medicare UPIN