Provider Demographics
NPI:1932130762
Name:BAILEY, WILLIAM CLARK III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLARK
Last Name:BAILEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4071 TATES CREEK CENTRE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3062
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:610 E BRANNON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-6046
Practice Address - Country:US
Practice Address - Phone:859-260-5540
Practice Address - Fax:859-260-5545
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY21203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64212038Medicaid
D95908Medicare UPIN
KY64212038Medicaid