Provider Demographics
NPI:1710089271
Name:BAILEY, CLAYTON RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:RAY
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10226 COULOAK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7675
Mailing Address - Country:US
Mailing Address - Phone:704-399-1415
Mailing Address - Fax:704-399-1415
Practice Address - Street 1:10226 COULOAK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7675
Practice Address - Country:US
Practice Address - Phone:704-399-1415
Practice Address - Fax:704-399-1415
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC96-00850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1052GOtherBCBS
NC891052GMedicaid
NC1052GOtherBCBS
G45600Medicare UPIN