Healthcare Provider Details

I. General information

NPI: 1093787897
Provider Name (Legal Business Name): BOYD LEE BAILEY II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MEDICAL CENTER PKWY SUITE 200
SELMA AL
36701-6750
US

IV. Provider business mailing address

1023 MEDICAL CENTER PKWY SUITE 200
SELMA AL
36701-6750
US

V. Phone/Fax

Practice location:
  • Phone: 334-875-4184
  • Fax: 334-874-3473
Mailing address:
  • Phone: 334-875-4184
  • Fax: 334-874-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00008853
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: