Provider Demographics
NPI:1336163450
Name:BAILS, RICHARD P (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:BAILS
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 1:2855 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1128
Mailing Address - Country:US
Mailing Address - Phone:510-549-8960
Mailing Address - Fax:510-549-8965
Practice Address - Street 1:2450 ASHBY AVE
Practice Address - Street 2:SUITE 2785
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-204-1691
Practice Address - Fax:510-204-5422
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG23592207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G235920Medicaid
CAA42009Medicare UPIN
CA00G235920Medicare ID - Type Unspecified