Provider Demographics
NPI:1992863971
Name:BAILES, DALLAS ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:ELLIOTT
Last Name:BAILES
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 1:360 NUECES ST
Mailing Address - Street 2:3704
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3826
Mailing Address - Country:US
Mailing Address - Phone:646-483-8677
Mailing Address - Fax:
Practice Address - Street 1:360 NUECES ST
Practice Address - Street 2:3704
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3826
Practice Address - Country:US
Practice Address - Phone:646-483-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238603207P00000X
TXM7020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine