Provider Demographics
NPI:1760567481
Name:BAILEY, JASON ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ERIC
Last Name:BAILEY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3825 ELECTRIC RD STE C
Mailing Address - Street 2:419 OFFICE CENTER
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4561
Mailing Address - Country:US
Mailing Address - Phone:540-777-1711
Mailing Address - Fax:540-777-1713
Practice Address - Street 1:2110 CAROLINA AVE SW FL 3
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1742
Practice Address - Country:US
Practice Address - Phone:540-777-1711
Practice Address - Fax:540-777-1713
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-07-10
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Provider Licenses
StateLicense IDTaxonomies
VA0110002428363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760567481Medicaid