Provider Demographics
NPI:1710988696
Name:BAILLY, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:BAILLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 MISSION ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6222
Mailing Address - Country:US
Mailing Address - Phone:503-585-5585
Mailing Address - Fax:503-587-7823
Practice Address - Street 1:885 MISSION ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6222
Practice Address - Country:US
Practice Address - Phone:503-585-5585
Practice Address - Fax:503-587-7823
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12677207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226811Medicaid
ORC92136Medicare UPIN