Provider Demographics
NPI:1295919512
Name:BAILEY, WILLIAM MERRILL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MERRILL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 VILLA ROAD STE 114
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1881
Mailing Address - Country:US
Mailing Address - Phone:503-538-9431
Mailing Address - Fax:503-538-2358
Practice Address - Street 1:308 VILLA ROAD STE 114
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1881
Practice Address - Country:US
Practice Address - Phone:503-538-9431
Practice Address - Fax:503-538-2358
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR175117Medicaid
OR080860OtherSAIF (WORKERS COMP)
OR0912210001OtherBLUE CROSS
OR175117Medicaid