Provider Demographics
NPI:1932141801
Name:LEE, BAILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:
Last Name:LEE
Suffix:
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 1:175 LENNON LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2485
Mailing Address - Country:US
Mailing Address - Phone:925-296-7156
Mailing Address - Fax:925-296-7174
Practice Address - Street 1:3901 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6200
Practice Address - Country:US
Practice Address - Phone:925-296-7156
Practice Address - Fax:925-296-7174
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG398432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G3984317Medicare PIN
CA00G398433Medicare PIN
CA00G398438Medicare PIN
CA300097066Medicare PIN
CA00G3984313Medicare PIN
CA00G3984318Medicare PIN
CA300096977Medicare PIN
CA00G398431Medicare PIN
CA00G3984319Medicare PIN
CA00G3984316Medicare PIN
CA00G398432Medicare PIN
CA00G3984321Medicare PIN
CA00G398439Medicare PIN
CA00G398435Medicare PIN
CA00G3984320Medicare PIN
CA00G398436Medicare PIN
CA300097018Medicare PIN
CA00G3984311Medicare PIN
CA00G3984312Medicare PIN
CA00G3984314Medicare PIN
CA00G398434Medicare PIN
CA300097041Medicare PIN
CAA47989Medicare UPIN
CA00G3984315Medicare PIN
CA00G398437Medicare PIN
CA00G3984310Medicare PIN