Provider Demographics
NPI:1679761704
Name:RICHARD BAILEY, M.D., L.L.C
Entity Type:Organization
Organization Name:RICHARD BAILEY, M.D., L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-763-1020
Mailing Address - Street 1:PO BOX 21944
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-1944
Mailing Address - Country:US
Mailing Address - Phone:928-763-1020
Mailing Address - Fax:928-763-2076
Practice Address - Street 1:3750 HWY 95
Practice Address - Street 2:SUITE 101
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6050
Practice Address - Country:US
Practice Address - Phone:928-763-1020
Practice Address - Fax:728-763-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG55860Medicare UPIN
AZZ121433Medicare PIN