Provider Demographics
NPI:1518322650
Name:FORD, BAILEY SLATER (PA)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:SLATER
Last Name:FORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1220 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-7118
Mailing Address - Country:US
Mailing Address - Phone:432-332-6600
Mailing Address - Fax:432-552-0992
Practice Address - Street 1:1220 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-7118
Practice Address - Country:US
Practice Address - Phone:432-332-6600
Practice Address - Fax:432-552-0992
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant