Provider Demographics
NPI:1932795259
Name:BAYLESS, WADE BRANSON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:BRANSON
Last Name:BAYLESS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1131 NW 64TH TER STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4261
Mailing Address - Country:US
Mailing Address - Phone:352-363-2025
Mailing Address - Fax:352-363-2026
Practice Address - Street 1:1131 NW 64TH TER STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4261
Practice Address - Country:US
Practice Address - Phone:352-363-2025
Practice Address - Fax:352-363-2026
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9113907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant