Provider Demographics
NPI:1134195449
Name:BAILEY, COLIN R (MD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:R
Last Name:BAILEY
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 1:2100 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-1271
Mailing Address - Country:US
Mailing Address - Phone:254-537-6160
Mailing Address - Fax:254-755-6695
Practice Address - Street 1:2100 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1271
Practice Address - Country:US
Practice Address - Phone:254-537-6160
Practice Address - Fax:254-755-6695
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124487301Medicare ID - Type Unspecified
TXF85022Medicare UPIN
TX8301J0Medicare ID - Type Unspecified