Provider Demographics
NPI:1821069998
Name:BAILEY, CARL G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:BAILEY
Suffix:JR
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:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402
Mailing Address - Country:US
Mailing Address - Phone:850-747-4905
Mailing Address - Fax:850-747-4907
Practice Address - Street 1:527 N PALO ALTO AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-763-2451
Practice Address - Fax:850-747-4907
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME548292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041915000Medicaid
FL08238OtherBCBS
FL08238ZMedicare PIN
FL041915000Medicaid
FL08238UMedicare PIN
FL08238VMedicare PIN