Provider Demographics
NPI:1598714818
Name:BAILEY, THOMAS SAMPLE JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SAMPLE
Last Name:BAILEY
Suffix:JR
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 1:26800 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 525
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8029
Mailing Address - Country:US
Mailing Address - Phone:949-364-1040
Mailing Address - Fax:949-365-7037
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 525
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8029
Practice Address - Country:US
Practice Address - Phone:949-364-1040
Practice Address - Fax:949-365-7037
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22648207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG226480Medicaid
CAA41657Medicare UPIN