Provider Demographics
NPI:1912927153
Name:BAILEY, LISA GAYE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYE
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 1:565 A ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2063
Mailing Address - Country:US
Mailing Address - Phone:541-482-9492
Mailing Address - Fax:541-482-9485
Practice Address - Street 1:565 A ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2063
Practice Address - Country:US
Practice Address - Phone:541-482-9492
Practice Address - Fax:541-482-9485
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD204572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130022Medicare ID - Type Unspecified