Provider Demographics
NPI:1619089141
Name:BAILEY, COURTNEY MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MITCHELL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1910
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:900 ROUND VALLEY
Practice Address - Street 2:PARK CITY MEDICAL CENTER
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060
Practice Address - Country:US
Practice Address - Phone:435-658-7000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT92-142320-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8597445OtherWORKERS COMP
UT870545614BA1OtherEDUCATORS MUTUAL
AZ774803Medicaid
ID806156700Medicaid
UT995OtherHEALTHY U
UT1502954OtherUMWA
WY117040600Medicaid
UT38386OtherPEHP
UT107006128101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT261705OtherDESERET MUTUAL
NV002083089Medicaid
UTPRA02122OtherMOLINA
UTQM0000075886OtherALTIUS
UT870545614BA1OtherEDUCATORS MUTUAL
UT050058247Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ID806156700Medicaid