Healthcare Provider Details

I. General information

NPI: 1477553543
Provider Name (Legal Business Name): RICHARD LEFROY BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 HWY 95 SUITE 101
BULLHEAD CITY AZ
86442-6050
US

IV. Provider business mailing address

PO BOX 21944
BULLHEAD CITY AZ
86439-1944
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-1020
  • Fax: 928-763-2076
Mailing address:
  • Phone: 928-763-1020
  • Fax: 928-763-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25327
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: