Provider Demographics
NPI:1255445557
Name:BAILIE, DARYL (MD)
Entity type:Individual
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First Name:DARYL
Middle Name:
Last Name:BAILIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:220 STANDIFORD AVE
Mailing Address - Street 2:STE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1159
Mailing Address - Country:US
Mailing Address - Phone:209-579-5628
Mailing Address - Fax:209-579-5637
Practice Address - Street 1:1810 N OLIVE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2500
Practice Address - Country:US
Practice Address - Phone:209-656-1577
Practice Address - Fax:209-656-9106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2015-12-08
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Provider Licenses
StateLicense IDTaxonomies
CAA44981208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A449811Medicaid
CAC04029Medicare UPIN
CA00A449811Medicaid
CA00A449810OtherBLUE SHIELD