Provider Demographics
NPI:1457372997
Name:BAILEY, COLIN ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:ERNEST
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 1:5780 OSAGE BEACH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3188
Mailing Address - Country:US
Mailing Address - Phone:573-302-0032
Mailing Address - Fax:573-302-0378
Practice Address - Street 1:5780 OSAGE BEACH PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3188
Practice Address - Country:US
Practice Address - Phone:573-302-0032
Practice Address - Fax:573-302-0378
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105982208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207677733Medicaid
F87937Medicare UPIN
MO207677733Medicaid