Provider Demographics
NPI:1669476990
Name:BAILEY, EVA J (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:J
Last Name:BAILEY
Suffix:
Gender:F
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:PO BOX 2457
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2457
Mailing Address - Country:US
Mailing Address - Phone:817-332-3664
Mailing Address - Fax:817-882-9888
Practice Address - Street 1:823 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2224
Practice Address - Country:US
Practice Address - Phone:817-332-3664
Practice Address - Fax:817-882-9888
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5299208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079577501Medicaid
TX0040CGOtherBCBSTX GROUP ID
TX038391101Medicaid
TX82931GOtherBCBSTX PROVIDER ID
TX079577501Medicaid
TX0040CGOtherBCBSTX GROUP ID
TX81111JMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #