Provider Demographics
NPI:1518170042
Name:BAILEY, JOSHUA (PAC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PAC
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 307
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0307
Mailing Address - Country:US
Mailing Address - Phone:801-294-6907
Mailing Address - Fax:801-294-6917
Practice Address - Street 1:5911 FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7352
Practice Address - Country:US
Practice Address - Phone:801-266-6483
Practice Address - Fax:801-266-6916
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5713739-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005781802Medicare ID - Type UnspecifiedMEDICARE ID
UT752992232OtherBLUE CROSS