Provider Demographics
NPI:1790760171
Name:BAILEY, LEAH A (DO)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 840
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-8703
Mailing Address - Country:US
Mailing Address - Phone:918-696-8800
Mailing Address - Fax:918-696-3879
Practice Address - Street 1:RR 6 BOX 840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-8703
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:918-696-3879
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3742207Q00000X
ARE 3442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1203742Medicaid
OK1203742Medicaid