Provider Demographics
NPI:1336423516
Name:BAILEY, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 N TRACY BLVD
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3451
Mailing Address - Country:US
Mailing Address - Phone:209-832-6018
Mailing Address - Fax:
Practice Address - Street 1:1420 N TRACY BLVD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3451
Practice Address - Country:US
Practice Address - Phone:209-832-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN