Provider Demographics
NPI:1891759031
Name:BAILES, JAMES R JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BAILES
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 1:1340 HAL GREER BOULEVARD
Mailing Address - Street 2:ATTN: TAMMIE SILVA
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3800
Mailing Address - Country:US
Mailing Address - Phone:304-526-2053
Mailing Address - Fax:
Practice Address - Street 1:1115 20TH ST STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2071
Practice Address - Country:US
Practice Address - Phone:304-399-4141
Practice Address - Fax:304-399-4145
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17593208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0108955000Medicaid
OH0921346Medicaid
WVF74109Medicare UPIN
WVF74109Medicare UPIN
OH0921346Medicaid