Provider Demographics
NPI:1265436141
Name:BAILEY, BRIAN KEITH (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2622
Mailing Address - Country:US
Mailing Address - Phone:606-324-3668
Mailing Address - Fax:606-324-0668
Practice Address - Street 1:500 14TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2622
Practice Address - Country:US
Practice Address - Phone:606-324-3668
Practice Address - Fax:606-324-0668
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00305213ES0103X
KY244094213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002375Medicaid
KY80000540Medicaid
KY90010612Medicaid
OH2549086Medicaid
KY1962601Medicare PIN
KYT61396Medicare UPIN
OH2549086Medicaid
KYP00198414Medicare PIN