Provider Demographics
NPI:1518446939
Name:BAILEY, DAVID (CPSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5266
Mailing Address - Country:US
Mailing Address - Phone:575-921-9632
Mailing Address - Fax:
Practice Address - Street 1:2010 PECAN DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4746
Practice Address - Country:US
Practice Address - Phone:575-921-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM758175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty