Provider Demographics
NPI:1639232622
Name:BAILEY, CHARLES WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
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 1:8500 SHOAL CREEK BLVD
Mailing Address - Street 2:BLDG. 3, SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7591
Mailing Address - Country:US
Mailing Address - Phone:832-723-2363
Mailing Address - Fax:713-722-8998
Practice Address - Street 1:8500 SHOAL CREEK BLVD
Practice Address - Street 2:BLDG. 3, SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7591
Practice Address - Country:US
Practice Address - Phone:832-723-2363
Practice Address - Fax:713-722-8998
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89453BMedicare ID - Type UnspecifiedPROVIDER NUMBER
TXC13065Medicare UPIN