Provider Demographics
NPI:1710057708
Name:BRADLEY B BAILEY MD INC
Entity Type:Organization
Organization Name:BRADLEY B BAILEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-258-6200
Mailing Address - Street 1:10755 F SCRIPPS POWAY PRKY
Mailing Address - Street 2:BOX 537
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:619-258-6200
Mailing Address - Fax:619-258-0028
Practice Address - Street 1:36485 INLAND VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:90595
Practice Address - Country:US
Practice Address - Phone:951-304-7103
Practice Address - Fax:951-304-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85086207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G85086Medicare ID - Type Unspecified
G33654Medicare UPIN