Provider Demographics
NPI:1972187458
Name:BAYLIFF, CORBIT LEROY (DO)
Entity Type:Individual
Prefix:DR
First Name:CORBIT
Middle Name:LEROY
Last Name:BAYLIFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N EMPORIA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3707
Mailing Address - Country:US
Mailing Address - Phone:316-858-3460
Mailing Address - Fax:316-858-3494
Practice Address - Street 1:707 N EMPORIA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3707
Practice Address - Country:US
Practice Address - Phone:316-858-3460
Practice Address - Fax:316-858-3494
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-11042207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program