Provider Demographics
NPI:1134379175
Name:BAILEY, ROBERT E (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BAILEY
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:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-582-5461
Practice Address - Street 1:222 S 27TH AVE
Practice Address - Street 2:MINOR CARE CLINIC
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7165
Practice Address - Country:US
Practice Address - Phone:601-450-3030
Practice Address - Fax:601-450-3031
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09411208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07735713Medicaid
MSD32867Medicare UPIN
MS512I120002Medicare PIN