Healthcare Provider Details

I. General information

NPI: 1336368661
Provider Name (Legal Business Name): MARK S BAILEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ACTIVE WAY
BENTON AR
72019-7566
US

IV. Provider business mailing address

PO BOX 3250
BENTON AR
72018-3250
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-0984
  • Fax: 501-847-1405
Mailing address:
  • Phone: 501-315-0984
  • Fax: 501-847-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-7064
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: