Provider Demographics
NPI:1265791123
Name:BAILEY, LISA RAE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RAE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3929-1 AIRPORT BLVD 5TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:251-660-5930
Mailing Address - Fax:251-660-5931
Practice Address - Street 1:150 S INGLESIDE ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1803
Practice Address - Country:US
Practice Address - Phone:251-660-5930
Practice Address - Fax:251-660-5931
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2021-11-04
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Provider Licenses
StateLicense IDTaxonomies
ALMD.35784208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1265791123Medicaid