Provider Demographics
NPI:1609863901
Name:BAILEY, JOHN IRA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:IRA
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 1:829 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-7873
Mailing Address - Country:US
Mailing Address - Phone:251-342-6443
Mailing Address - Fax:251-342-6566
Practice Address - Street 1:829 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7873
Practice Address - Country:US
Practice Address - Phone:251-342-6443
Practice Address - Fax:251-342-6566
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7962207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00102751361OtherAMA MEDICAL EDUCATION NO.
AL51076187OtherBLUE CROSS BLUE SHIELD
AL76187OtherBLUE CROSS BLUE SHIELD
AL7962OtherMEDICAL LICENSE NUMBER
AL051076187OtherBLUE CROSS BLUE SHIELD
AL40245Medicare ID - Type Unspecified
AL051076187OtherBLUE CROSS BLUE SHIELD