Provider Demographics
NPI:1184906729
Name:BAILEY MEDICAL GROUP LLC
Entity type:Organization
Organization Name:BAILEY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-860-2488
Mailing Address - Street 1:2000 S DIXIE HWY
Mailing Address - Street 2:#105B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2456
Mailing Address - Country:US
Mailing Address - Phone:305-860-2488
Mailing Address - Fax:305-285-2422
Practice Address - Street 1:2000 S DIXIE HWY
Practice Address - Street 2:#105B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2456
Practice Address - Country:US
Practice Address - Phone:305-860-2488
Practice Address - Fax:305-285-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9465208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417969239OtherPERSONAL NPI