Healthcare Provider Details

I. General information

NPI: 1316963416
Provider Name (Legal Business Name): MR. ROBERT BLAIR BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7635 COUNTS MASSIE RD
NORTH LITTLE ROCK AR
72113-6656
US

IV. Provider business mailing address

7635 COUNTS MASSIE RD
NORTH LITTLE ROCK AR
72113-6656
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-0330
  • Fax: 501-224-0356
Mailing address:
  • Phone: 501-224-0330
  • Fax: 501-224-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number112590-60-001
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: