Provider Demographics
NPI:1710376439
Name:LAWRENCE RAY BAILEY MD PLLC
Entity Type:Organization
Organization Name:LAWRENCE RAY BAILEY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-226-3436
Mailing Address - Street 1:1711 W WHEELER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-4536
Mailing Address - Country:US
Mailing Address - Phone:361-226-3434
Mailing Address - Fax:361-758-4949
Practice Address - Street 1:1711 W WHEELER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:361-226-3434
Practice Address - Fax:361-758-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9158208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144770Medicare UPIN