Provider Demographics
NPI:1457351926
Name:BAILEY, GREGORY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1055 BOWLES AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2308
Mailing Address - Country:US
Mailing Address - Phone:314-925-4773
Mailing Address - Fax:314-925-4775
Practice Address - Street 1:1035 BELLEVUE AVE STE 500
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1843
Practice Address - Country:US
Practice Address - Phone:314-925-4773
Practice Address - Fax:314-925-4775
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2012-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO36457207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO004010977Medicare ID - Type Unspecified
202618203Medicare ID - Type Unspecified
E46068Medicare UPIN