Provider Demographics
NPI:1790145142
Name:BAILEY, BETTY (MD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 MAGNOLIA ST
Mailing Address - Street 2:LOT 16
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3547
Mailing Address - Country:US
Mailing Address - Phone:228-604-2626
Mailing Address - Fax:228-896-6036
Practice Address - Street 1:1529 MAGNOLIA ST
Practice Address - Street 2:LOT 16
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3547
Practice Address - Country:US
Practice Address - Phone:228-604-2626
Practice Address - Fax:228-896-6036
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS06441207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology