Provider Demographics
NPI:1356353676
Name:BAILEY, KELVIN EUGENE (MD)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:EUGENE
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 1:304 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-7101
Mailing Address - Country:US
Mailing Address - Phone:573-765-5131
Mailing Address - Fax:573-765-3122
Practice Address - Street 1:304 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556-7101
Practice Address - Country:US
Practice Address - Phone:573-765-5131
Practice Address - Fax:573-765-3122
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001019041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG94801Medicare UPIN
MO010013888Medicare ID - Type UnspecifiedPART B MEDICARE NUMBER